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UNITED STATES OF AMERICA. 



DIAGNOSIS BY THE 
URINE 



THE PRACTICAL EXAMINATION OF URINE WITH 
SPECIAL REFERENCE TO DIAGNOSIS. 



/ 



ALLARD MEMMINGER, M.D., 

PROFESSOR OF CHEMISTRY AND OF HYGIENE IN THE MEDICAL COLLEGE OF THE 

STATE OF SOUTH CAROLINA; VISITING PHYSICIAN IN THE 

CITY HOSPITAL OF CHARLESTON, ETC., ETC. 



ILLUSTRATED. 



PHILADELPHIA: /(g>Q f^y 

P. BLAKISTON, SON & CO., 

IOI2 WALNUT STREET. 

1892. 



iv 



V5 



Copyright, 1892, by P. Blakiston, Son & Co. 



Press of Wm F. Fell &. Co., 
1220-24 Sansom St., 

PHILADELPHIA. 



£)*di«jtti0tt* 



TO STUDENTS OF MEDICINE AND PRACTITIONERS AT LARGE 
THIS LITTLE VOLUME IS DEDICATED. 

THE ATTEMPT AT SIMPLICITY OF ARRANGEMENT AND OF STYLE 

IT IS HOPED WILL COMMEND IT TO THEM, AND BE THE 

MEANS OF INCREASING THEIR KNOWLEDGE AND 

DIMINISHING THEIR LABOR IN THIS SPECIAL 

DEPARTMENT OF SCIENCE. 



PREFACE. 



The necessity for a short, practical and systematic 
treatise on diseases which may be diagnosed by 
means of the urine, has for some time appeared to 
me great. 

True, we have many good works on diseases of the 
kidney and urinary organs, but they in all instances 
are either too comprehensive or else too special for 
the busy practitioner or medical student. Some 
excellent little books on urinary analysis have also in 
the past few years appeared, but they have not for 
their object the plan of the modest little book I now 
launch on the sea of medical progress. 

My aim has been to present at once the leading 
characteristics of the urine in health and in disease ; 
to show definitely how each test is to be applied, and 
what deductions are to be drawn from the result of 
such examination. 

I have purposely made the number of tests small, 
but have in all instances stated what I believe to be 

iii 



IV PREFACE. 

the most reliable practical tests for the student of 
medicine or practitioner at large. 

I feel and fear my aim has been beyond my ability 
to accomplish, and that in striving after simplicity 
and practicality I may have fallen in the sight of my 
readers. 

I shall, however, hope that my little book, launched 
as I have said, on the sea of progress, will meet with 
but few storms in the ocean of adverse criticism, and 
that in laying no claim to entire originality in this 
work I may be allowed the privilege of thanking col- 
lectively, and not individually, the various authors I 
have consulted. A. M. 

44 Hasell St. y Charleston, S. C. 
March ist, 1892. 



CONTENTS. 



PAGE 

Introduction, 9 

CHAPTER I. 

Physical Characteristics of Urine in Health, n 

Amount, n 

Specific Gravity, 12 

Consistence, 14 

Color, 14 

Transparency and Odor, 15 

Reaction, 15 

CHAPTER II. 
Deviations in the Physical Characteristics of Urine in 

Disease, 16 

Amount, 16 

Specific Gravity, 17 

Color, 18 

Transparency and Odor, 20 

Reaction, 21 

CHAPTER III. 
Deviations in the Normal Chemical Composition of Urine 

in Disease, 24 

Urea, 24 

Estimation of Urea, 26 

Uric Acid, 30 

Chlorides, 33 

Phosphoric Acid, 35 

V 



VI CONTENTS. 

CHAPTER IV. 

PAGE 

Morbid Products in the Urine in Disease 39 

Albumen, 39 

Sugar, 43 

Composition of Fehling's Solution, 48 

Coloring Matters, 48 

Leucine and Tyrosine, 48 

Blood, 50 

Pus, . , '. 53 

CHAPTER V. 

Morbid Products which are Properly Classified as 

Urinary Sediments and Urinary Calculi, ... 56 

Urinary Sediments, 56 

CHAPTER VI. 

Resume, 60 

Diagnosis of Diseases of the Kidney and Urinary Organs, . 60 

Parenchymatous Nephritis, 64 

Chronic Parenchymatous Nephritis, 65 

Interstitial Nephritis, 66 

Pyelitis and Cystitis, . 68 

Index, 75 



LIST OF ILLUSTRATIONS. 



FIG. PAGE 

1. Urinometer, 12 

2. Ureometer of Dr. Doremus, 27 

3. Forms of Uric Acid, 31 

4. Esbach's Albumenometer, 41 

5. Graduated Burette, 46 

6. Leucin Balls, Tyrosin Sheaves, Double Balls of Ammonium 

Urate, 49 

7. Colored and Colorless Blood Corpuscles of Various Forms, . 51 

8. Shriveled Blood Corpuscles in Urine (Catarrh of the Bladder) 

with Numerous Lymph Corpuscles and Crystals of Triple 

Phosphate, 51 

9. Haemin Crystals, 54 

10. Deposit in Ammoniacal Urine (Alkaline Fermentation), . . 54 

11. Acid Ammonium Urate, 57 

12. Crystals of Cystin, Oxalate of Lime, 58 

13. Oxalate of Lime, 58 

14. Coarsely Granular Casts, 73 

15. Acid Sodic Urate in Cylinders, 73 

16. Leucocyte Cast, 73 

17. Blood Cast, . 73 

18. Hyaline Cast, 73 

19. Epithelial Cast, 73 

20. Finely Granular Cyst, 74 

21. Peculiar Changes of the Red Blood Corpuscles in Hematuria, 74 

22. Crenated Red Blood Corpuscles in Renal Hematuria, ... 74 

23. Deposit in Acid Fermentation of Urine, 74 



Vll 



INTRODUCTION. 



The urine is the secretion of the kidneys, 
and normally considered is a solution of tissue 
which has undergone retrograde metamorphosis. 
The process by which this is brought about is a 
double one : filtration, which occurs chiefly in 
the Malpighian capsules of the kidney, and 
excretion, which is brought about by means of 
the epithelial lining of the tubules of the kidney. 
Although then this is true for all practical pur- 
poses, still the lines are not so accurately de- 
fined as this, a certain though small proportion 
of the excretion taking place through the Mal- 
pighian tufts, and conversely a certain percent- 
age of water being excreted along with the 
solids by means of the epithelium of the tubules. 
The average composition of this fluid is as 
follows : — 

Total solids, 60 to 65 grammes. 

L'rea, 30 "35 



IO DIAGNOSIS BY THE URINE. 

Uric acid, 0.5 to 0.8 grammes. 

Chlorides, 10 "12 " 

Phosphoric acid, 2.5 " 3.0 " 

Earthy phosphates 1 "1.3 " 

Sulphuric acid, 1.5 " 2.5 

Hippuric acid 0.25 " 0.5 " 

Creatinine, 0.5 " 1.0 

In disease the urine, besides showing devia- 
tions in the normal constituents and physical 
characteristics, contains albumen, sugar, biliary 
coloring matter, acids and fats, uroerythrine 
(red coloring matter), ammonium sulphide, 
blood, leucine and tyrosine, carbonate and 
oxalate of calcium, carbonate of ammonium, 
cystine, xanthine, pus, epithelium, spermatozoa, 
and fungi. 



DIAGNOSIS BY THE URINE. 



CHAPTER I. 

PHYSICAL CHARACTERISTICS OF URINE 
IN HEALTH. 

AMOUNT. 

The average quantity of urine passed in the 
twenty-four hours by one in health is 1500 c.c., 
or 50 fluidounces ; most is passed in the after- 
noon, less in the morning, and least at night. 

Of course, the amount passed will be much 
influenced by the quantity of fluid taken into 
the system ; but the above is the general average 
for winter, in health, and a variation of 400 c.c. 
either way must be allowed, not constituting in 
this variation a condition of disease. In sum- 
mer the average quantity of water passed is 
about 1200 c.c, and the same degree of varia- 
tion must be allowed as just here stated. 
2 11 



12 



DIAGNOSIS BY THE URINE. 



SPECIFIC GRAVITY. 
The specific gravity of normal urine for the 
twenty-four hours (1500 c.c.) ranges between 
1.020 and 1.022, and is easiest obtained by means 



Fig. 1. 




Urinometer. 



of the urinometer, as follows : Fill a small stand- 
ing glass cylinder four-fifths full of the urine, re- 
move all froth by means of filter paper, and place 
in cylinder the urine float (hydrometer) ; do not 



PHYSICAL CHARACTERISTICS IN HEALTH. I 3 

allow the float to touch sides, and read depth to 
which hydrometer sinks ; the number so found, 
if urine has temperature of 6o° to 62 F., repre- 
sents the specific gravity. If the temperature is 
above or below, wait until it becomes 6o° or 62 , 
and then make your observations.* 

From the specific gravity we can approx- 
imately and for all usual clinical purposes cal- 
culate the solids excreted in the twenty-four 
hours. The rule is as follows : Multiply the 
decimal of the specific gravity by 2.33 and the 
result will represent the weight of solids con- 
tained in 1000 c.c. of urine; hence we can, if we 
have the quantity of urine passed in twenty- 
four hours, estimate the weight of solids con- 
tained in whole. For example, patient passed 
3000 c.c. of urine of specific gravity 1.015, 
therefore 15 x 2.33 = 34.95 grammes of solids 
contained in 1000 c.c. Consequently, to arrive 
at amount in 3000 c.c. we say, 

1000 : 3000 : : 34.95 : x 

x = 104.85 grammes. 

If a more accurate determination of the solid 

* Hydrometers, carrying temperature chart on them, can be 
procured at Messrs. Eimer & Amend, of New York. 



14 DIAGNOSIS BY THE URINE. 

matter is desired the same is readily attained 
by evaporating a definite quantity of urine on 
the water bath, drying at 21 2° F. the residue 
thus obtained, and then by means of the chemi- 
cal balance ascertaining its weight. 



CONSISTENCE. 

Normal urine is a thin and easily dropping 
fluid, and only becomes viscid when it has 
undergone or is undergoing some pathological 
change. It also on being shaken foams, but 
the same subsides and vanishes very soon after ; 
if, however, it contains sugar or albumen, the 
foam remains for a long while. 



COLOR. 

The color of normal urine is a bright amber 
or sherry wine yellow if the entire quantity for 
the twenty-four hours (1500 c.c.) is taken ; if 
not the color varies in consequence to the time 
of day taken. On rising in the morning it is 
darker, and during the day, and particularly 
after dinner, the tint is less strong. 



PHYSICAL CHARACTERISTICS IN HEALTH. I 5 

TRANSPARENCY AND ODOR. 
Normal urine is always clear and transparent, 
and shows on standing a cloud of mucus ; this 
mucus is only mechanically suspended in the 
urine, and not in any wise dissolved ; the odor 
is sharp and slightly aromatic, and its cause is 
at present unknown. 



REACTION. 

The reaction of normal urine for the twenty- 
four hours is slightly acid, the same being 
caused by the presence of acid phosphates of 
the alkalies. To determine whether or not a 
urine is acid, moisten a slip of blue litmus paper 
with the secretion, and if it changes from blue 
to red the urine is acid ; should the urine show 
an excessive degree of acidity, it is a sign that 
the urine is passing from a normal state to an 
abnormal one. Having now considered the 
general physical characteristics of normal urine, 
let us pass on to consider a deviation from 
these, and note those points which mark the 
beginning of disease in the urinary organs. 



CHAPTER II. 

DEVIATIONS IN THE PHYSICAL CHARACTERISTICS 
OF URINE IN DISEASE. 

AMOUNT. 

xA.s has been previously said, the amount of 
urine passed in health in the twenty-four hours 
is about 1500 c.c, or say 50 fluidounces. If the 
quantity is much increased and habitually so, 
we have a condition of things known as Poly- 
uria ; if, on the other hand, much diminished, 
a condition known as Oliguria ; and if entirely 
suppressed, Anuria. 

Polyuria may be either physiological or 
else pathological ; in the first instance it is 
called urina potus (from excessive taking in 
of fluids), and in the second hydruria or dia- 
betes. To make a differential diagnosis in 
these cases the total quantity of solids passed 
in the twenty-four hours is requisite, so this 
brings me at once to consider the deviations 
in specific gravity which constitute disease. 

16 



PHYSICAL CHARACTERISTICS IN DISEASE. I 7 

SPECIFIC GRAVITY. 
The specific gravity of normal urine, as has 
been said, is 1.020 to 1.022, and any decided 
deviation in either direction, provided it is 
habitual, is an evidence of disease. As in the 
case of the total quantity of urine passed in the 
twenty-four hours, it was shown that an allow- 
ance, excessive or the reverse, to the amount of 
400 c.c. must be allowed, so in the specific 
gravity a variation of two degrees either way 
by itself indicates nothing; when, however, a 
urine falls habitually below (much or little) 1 .018, 
or goes above 1024 (much), it is an evidence 
in the first instance of a pathological hydruria, 
and in the second of a condition known as poly- 
uria. This latter condition is commonly called 
diabetes, and is of two kinds : Diabetes insip- 
idus, where the solids are all increased, but no 
sugar ; in the latter condition it is called Dia- 
betes Mellitus. As examples of these different 
kinds of urine, I will say that in the first class 
of urines, the true pathological hydrurias, we 
have a urine of low specific gravity, 1.002 or so, 
and large quantities of water, 4000 to 6000 c.c. 
On calculating the total solids, it will be found 
that they are much diminished, whereas the 



1 8 DIAGNOSIS BY THE URINE. 

water is in a corresponding degree increased 
above the normal. In the second class of urines 
the hydrometer shows a specific gravity of 1.025 
to 1.030, and the quantity of water is also con- 
siderably increased, being 1500 c.c. to 2500 c.c. 
in the twenty-four hours. In these urines, if no 
sugar is found, the increase in solids is most 
surely due to excessive quantity of urea or else 
phosphoric acid. If the increase of solids is 
due to an increase of phosphates, it is called 
phosphaturia ; when, however, sugar is the 
cause of the increased specific gravity, it is 
called diabetes mellitus.* 



COLOR. 

Deviations in color mark the beginning of 
pathological changes going on in the urinary 
organs. Colorless urines of low specific gravity 
and excessive increase of water, 4000 c.c. to 

* A condition known as chyluria and simulating phosphatic 
diabetes sometimes occurs ; the urine here is thick and heavy 
and appears as a milky white liquid. It coagulates readily on 
being heated, as it contains much fibrine, and the coagulum 
does not dissolve on the addition of acetic acid as would the 
phosphates ; this reaction, therefore, together with the presence 
of fat, renders the differential diagnosis in these cases easy. 



PHYSICAL CHARACTERISTICS IN DISEASE. 1 9 

6000 c.c, evidence a neurotic affection. Color- 
less urines, again, with habitual low specific 
gravity, 1.010 to 1.005, but not necessarily an 
increase of water, point to atrophy of the kid- 
ney as the probable cause; as the disease 
advances, however, the water increases beyond 
the normal. Urines also appear dark yellow- 
red, bright garnet-red, dark brown, and green- 
ish-yellow. The color in dark yellow-red urines 
is due either to blood or else to a coloring 
matter called uroerythrine. As the considera- 
tion of the morbid constituents found in urine 
is to be considered separately, together with 
the consideration of the other colors named, I 
will defer this until later on, and will consider 
urines colored garnet-red, as this color is 
generally due to foreign vegetable coloring 
matters. Take three drachms of clear urine 
(filter if not clear), add to the same in a test 
tube ten drops of nitric acid (strong) and boil 
for a minute ; if the red is not due to pathologi- 
cal changes in the urine, the color will disap- 
pear, and on the addition of an alkali it will 
return, to be again dissolved when the urine is 
again acidified by nitric acid and heated. 



20 DIAGNOSIS BY THE URINE. 

TRANSPARENCY AND ODOR. 

Normal urine being clear and transparent, 
with only floating particles of mucus, a urine 
deviating much from this is an indication of 
disease in the urinary organs. To determine 
this, take a portion of the twenty-four hours' 
urine, place in a glass cylinder and stand same 
on piece of white paper ; by this we can not 
only determine the amount of floating matter in 
the urine, but also, from the same specimen, the 
color, specific gravity, odor, and reaction. If 
the urine by this procedure appears thick and 
cloudy, it may be due simply to an insufficiency 
of water or else to morbid changes. To differ- 
entiate these conditions, heat the urine in a test 
tube, and if all dissolves, the turbidity was due 
to urates ; if, on heating, instead of clearing up 
it becomes more turbid, add a few drops of 
acetic acid, and if it now clears up, it is an 
evidence that the urine was too concentrated 
and therefore the solids precipitated out. 

If, finally, the urine appears with the addition 
of acid and heat as it does without them, the 
turbidity is surely due to bladder or kidney 
detritus, and may therefrom be taken as an 
indication of disease. 



PHYSICAL CHARACTERISTICS IN DISEASE. 2 1 
REACTION. 

Normal human urine shows in the twenty- 
four hours' urine a slightly acid reaction ; if, 
however, the urine is taken at different periods 
of the day, it will be found that the acidity 
varies. Shortly after a meal the urine is 
slightly alkaline, but after a while it again rights 
itself. If the urine shows too decided an acid 
reaction it is abnormal, and marks either an 
excessive quantity of uric acid present or else 
an acid condition of the urine caused by free 
acid. This latter condition is easily determined 
by taking three drachms of the twenty-four 
hours' urine (clear, and if not, filtered so as to 
make it so), placing it in a test tube and pour- 
ing into it one-half the quantity of a strong 
solution of the hyposulphite of sodium. If free 
acid be present, a turbidity immediately forms 
whose density is in proportion to the quantity 
of acid present. This reaction is caused by the 
precipitation of sulphur, the free acid having 
united with the sodium of the salt. 

The reaction, again, of urine may deviate 
in the opposite direction, constituting an alka- 
line urine, and therefore indicating disease. 
There are two ways in which the urine may 



2 2 DIAGNOSIS BY THE URINE. 

become alkaline, and it is very important, from 
a clinical standpoint, to name and understand 
them. The first is from fixed alkali and the 
second from volatile (carbonate of ammonia). 

Both forms of alkaline urine change re d 
litmus paper to blue on being moistened, but in 
the case of fixed alkali, litmus paper on being 
dried does not regain its red color, whereas in 
the case of urine rendered alkaline from vola- 
tile alkali, the red litmus paper regains its color 
on being dried. Urine showing the presence 
of volatile alkali is always an evidence of disease 
(inflammation) of some part of the genito- 
urinary apparatus. 

If there be both fixed and volatile alkali 
present in the urine, the above test will give a 
negative result ; so important, however, is it for 
us to know whether or not volatile alkali is 
present, and therefore if inflammation is to be 
excluded, that we proceed as follows : Place 
ioo c.c. of the urine in a glass flask to which Is 
fitted a cork ; on inserting the cork allow a slip of 
moistened red litmus paper to be placed against 
its side and extending down into the flask, but 
not reaching into the urine ; heat gently (do not 
boil) the flask, and if any carbonate of ammonia 



PHYSICAL CHARACTERISTICS IN DISEASE. 23 

is present the red litmus paper will immediately 
turn blue. I suppose it is needless for me to 
caution that this test must always be applied to 
fresh urine. 

Urines alkaline from fixed alkali generally 
effervesce on the addition of an acid, and though 
not indicating any particular derangement of 
the kidneys, are usually met with in enfeebled 
conditions of the body in which the respiratory 
act is performed with difficulty, and thus car- 
bonic acid is allowed to accumulate in the 
system ; also whenever the bile is diminished, 
or when there is a tendency to fermentative 
changes in the stomach or intestines. The 
dyspepsia which accompanies this kind of urine 
is attended with great depression of spirits ; 
flatulence is marked, the bowels confined, and 
the skin dark and sallow, showing evident 
derangement of the liver. 



CHAPTER III. 

DEVIATIONS IN THE NORMAL CHEMICAL COM- 
POSITION OF URINE IN DISEASE. 

UREA. 

From a clinical standpoint, of all the normal 
constituents found in human urine, we need 
only consider urea, uric acid, chlorides and 
phosphates of the alkalies, and alkaline earths. 
Urea is the main solid which is passed in the 
urine, and averages from 30 to 35 grammes 
(460 to 540 grains) in the twenty- four hours. 
It is a di-ureide, and has the formula CON 2 H 4 . 

The quantity of urea excreted from the body 
in the twenty-four hours is much influenced by : 
1. The amount of nitrogenous food supplied 
the system ; 2. Amount of active exercise taken 
during the day ; and 3. The quantity of water 
drank. If the three indications are all met, why 
then urea increases very much in the urine. If, 
however, the amount increases and the three 
conditions mentioned are not given, why then 

24 



ABNORMAL CHEMICAL COMPOSITION. 25 

the increase is an approximate evidence of the 
waste of the system. This takes place in all 
fevers and wasting diseases, and as long as the 
liver and kidneys remain intact, the former to 
manufacture and the latter to convey away 
retrograde tissue products, why then the esti- 
mate from day to day of the urea in the urine 
will be a pretty fair approximate estimate of the 
wearing away of tissue, and consequently of 
the loss of vital force. When urea, instead of 
being increased, is found to have decreased, 
why then it is an evidence of either a diseased 
condition of the liver or kidneys. It is sur- 
prising to see, however, how low the urea 
finally runs in some cases before the fatal hour 
arrives. I have notes of a case treated for two 
months, and on no occasion during this time 
was there more passed than 13.52 grammes in 
the twenty-four hours. We can safely say, 
therefore, that when urea in the urine of the 
twenty-four hours habitually falls below 20 
grammes in the case of an adult of active pur- 
suits and well-nourished body, that we should 
suspect disease of the liver or else of the 
kidneys. 



2 6 DIAGNOSIS BY THE URINE. 

ESTIMATION OF UREA. 
The manner in which the estimation of urea 
is made is very simple and sufficiently accurate 
for clinical purposes. It is founded on the 
decomposition of urea by the action of such an 
agent as the hypobromite of soda. 

H 4 CON 2 + 3NaBrO = N 2 + C0 2 + 2H 2 + 3NaBr. 

The results would be a little low if urine 
contained alone urea, but since we find in it 
also uric acid, urates, and kreatinin, these in 
giving up their nitrogen make up for the loss, 
and thus nicely counterbalance this source of 
error. The manipulation of the process is as 
follows : We advise for use the most excellent 
ureometer designed by Dr. Charles Doremus, 
of New York, and to whom, allow me to say, 
the profession owes a debt of gratitude for 
making so simple a process which has hereto- 
fore been so the reverse. These ureometers 
are graduated according to the French and 
English systems, respectively; the manipulation 
with either is the same, but the calculations 
being different, I deem it best to describe the 
procedure with each. 

i. Make a solution of sodium hydrate, 100 



ABNORMAL CHEMICAL COMPOSITION. 



27 



grammes to 250 c.c. of distilled water. Keep 
this in bottle with rubber stopper. 

2. Make solution of hypobromite by adding 
1 c.c. of bromine to 10 c.c. of sodium hydrate 



Fig. 2. 




Ureometer of Dr. Doremus. 



solution, and diluting with 10 c.c. of distilled 
water. 

It is convenient, instead of making this solu- 
tion previously (and which does not keep long), 
to pour directly into the ureometer the sodium 

3 



28 DIAGNOSIS BY THE URINE. 

hydrate solution until the liquid rises to the 
mark = which is on each ureometer ; by means, 
now, of a little nipple pipette, which goes with 
each set, measure out i c.c. of bromine, add 
this to the hydrate solution, and after the bro- 
mine has all gone into solution, dilute by pour- 
ing in water so as to fill the long arm and bend 
of the ureometer; see now that the instrument 
is full and thoroughly luted at the bend in the 
arm, which is easily attained by tilting and 
then raising again until all air has been ex- 
pelled and you have a thorough and complete 
mixture. 

The instrument is now in condition for your 
test, and the remarks made are true for the 
English, as well as for the French instrument I 
am describing. 

Draw up by means of the pipette i c.c. of 
urine to be tested ; if the urine contains much 
albumen, free it of the same by heating but not 
boiling ; if the quantity, however, is small, dis- 
regard it and pass the pipette into the ureo- 
meter as far as the bend and compress the 
rubber on end of pipette, thereby causing 
urine to ascend in hypobromite slowly ; on so 
doing there is great disengagement of gas 



ABNORMAL CHEMICAL COMPOSITION. 29 

(carbonic acid and nitrogen), and after the dis- 
turbance is over and several minutes is allowed 
to elapse, the volume of nitrogen may be read, 
as the column of liquid in the ureometer will be 
depressed just in proportion to the quantity of 
evolved gas, the carbonic acid gas being all 
absorbed by the hydrate of sodium. Each 
division mark on the ureometer indicates 0.001 
gramme of urea in 1 c.c. of urine. The quan- 
tity, therefore, of urea voided in the twenty-four 
hours is ascertained by multiplying the result 
of the test by the number of c.c. of urine 
passed during that period. When the English 
ureometer is used, divided as it is into grains, 
the solutions are prepared and calculations 
made as follows : — 

1. Make a solution of sodium hydrate, six 
ounces to the pint of distilled water; keep this 
in bottle with rubber stopper. 

2. Make solution of hypobromite of sodium 
as previously described, and proceed exactly in 
the same way with the urine, etc. 

Each division on this ureometer indicates one 
grain of urea in one fluidounce of urine; the 
quantity, therefore, of urea voided in the twenty- 



30 DIAGNOSIS BY THE URINE. 

four hours is ascertained by multiplying the 
result of the test by the number of ounces of 
urine passed during that period. 



URIC ACID. 

Uric acid is found only in small quantity in 
human urine, and, when occurring in excessive 
amounts its great insolubility in water causes it 
to at once crystallize out. This unfortunately 
frequently takes place in the kidneys, and thus 
concretions are lodged there which form foci of 
irritation, and finally, if allowed to continue, 
eventuate in one or other of the chronic forms 
of nephritis. 

Uric acid, also in union with sodium, potas- 
sium and calcium, is often found in large quan- 
tity in urine, principally, we may say, in the 
beginning of fevers and in all conditions in 
which the system is subjected to either a short, 
high temperature, or else a lower temperature 
of longer duration. Along with these urates is 
precipitated a coloring matter, called uroery- 
thrine ; this coloring matter is red and gives to 
uric acid and urate deposits a rosy red tint, the 



ABNORMAL CHEMICAL COMPOSITION. 3 I 

so-called brick dust deposit, so often observed 
in the pot de chambre in the morning. If this 
deposit habitually occurs in the urine of persons 
not suffering from fever, it is a sign that the 




liver is at fault, and that the gouty or rheumatic 
gout diathesis is being established. The pres- 
ence of uroerythrine, uric acid, and urates is 
most easily told. 

If these are present the urine will be turbid, 



32 DIAGNOSIS BY THE URINE. 

the urates will clear up on being heated, and 
the uric acid will be dissolved if to the sedi- 
ment is added an alkali. To determine the 
presence of uroerythrine take three drachms 
of urine, place in a test tube, add one to three 
drops of a solution of the acetate of lead, and 
if it is present a precipitate of a rosy pink (flesh 
colored) will immediately fall. When uric acid 
occurs in abnormal amounts it will be found, if 
the case is one of true lithaemia, that all the 
other solids are diminished; this state of things 
points strongly to grave diseases of the liver, 
acute yellow atrophy, cirrhosis and cancer. If 
the urine for the twenty-four hours is near the 
normal amount, and uric acid crystallizes out a 
short, while after standing, it is in abnormal 
quantity. Its detection is readily made in the 
following manner : Filter, if the urine is not 
clear, ioo c.c, acidify with 10 c.c. of strong 
hydrochloric acid, allow it to stand, and after 
twelve hours uric acid will be found crystallized 
and can be verified by either the microscope or 
else by the murexide test, which is performed 
as follows : Take a few of the crystals ; place on 
a watch glass, add a few drops of nitric acid 
and apply heat gently ; after thus attaining 



ABNORMAL CHEMICAL COMPOSITION. 33 

solution of the uric acid dry carefully over the 
flame, and to the dry and cool mass add a few 
drops of ammonia ; if the crystals be uric acid 
a most magnificent purple color will rapidly 
spread over the touched mass. 



CHLORIDES. 

In the urine of men and women the chlorides 
consist almost entirely of chloride of sodium, 
and the average quantity passed in twenty-four 
hours is between twelve and thirteen grammes, 
consequently it ranks next to urea as the prin- 
cipal constituent in urine. The quantity of 
chlorides present is subject, as with the other 
constituents, to fluctuations ; when, however, the 
average falls much below the figures just given, 
it is A sign of disease of the kidneys, or else of 
the final stage of some lung trouble or con- 
tinued fever. Whenever, in pneumonia, the 
chlorides leave the urine the case must be 
regarded as very serious. In cases of chronic 
nephritis the regular and habitual falling off of 
chloride of sodium in the urine gives to the case 
a serious and grave aspect. The chlorides are 



34 DIAGNOSIS BY THE URINE. 

not increased in pathological urines, but are 
sometimes found in larger quantities than usual 
when a salt diet is instituted. 

To determine whether they are in normal or 
diminished quantity, take two ounces of urine, 
filter if not perfectly clear, and if albumen is 
present heat with nitric acid and filter. Take 
the filtrate in this case, or, if albumen is not pre- 
sent, the clear urine, and acidify with nitric acid, 
add to it four drops of a solution of nitrate of 
silver, strength I part, AgNO s to 8 parts H 2 0, 
and if chlorides are in normal quantity, y 2 to i 
per cent., thick curdy masses of chloride of 
silver (AgCl) immediately fall to the bottom of 
the test glass. If, on the other hand, the urine 
contains a small quantity of the chloride, say 
one-eighth to one-tenth of one per cent., the 
solution (urine re), after the addition of the 
silver nitrate, shows only a cloud, and instead of 
the thick masses falling to the bottom, which do 
not mix readily with the urine, we have a solu- 
tion of milky and turbid appearance. 



ABNORMAL CHEMICAL COMPOSITION. 35 

PHOSPHORIC ACID. 
The amount of phosphoric acid passing from 
the system in the course of twenty-four hours 
is, as we have said, 2.5 to 3.0 grammes, and is 
distributed among the bases, lime, magnesia, 
soda, and potassa. Two-thirds is in combina- 
tion with the oxides of the alkalies, and the 
remaining one-third in union with the oxides of 
the alkaline earths. The alkaline phosphates 
are extremely soluble and are never deposited 
from the urine ; on the other hand, the earthy 
phosphates are only held in solution by the acid 
of the urine, and so soon as this is changed to 
a neutral or alkaline state, a deposition takes 
place. To approximately determine the 
quantity of phosphoric acid in the urine: esti- 
mate by rule already given, the total quantity 
of solids in the urine, expressed in grammes ; 
then by the hypobromite method the total 
quantity of urea, expressed also in grammes; to 
this add eighteen grammes, and subtract the 
same from the total solids, and the quotient 
divided by four will give the approximate 
quantity of phosphoric acid (P 2 5 ) passing 
from the body. Thus, for example, the total 
quantity of solids found in a certain specimen 



36 DIAGNOSIS BY THE URINE. 

of urine was 89.00 grammes, the quantity of 
urea was found to be 32 grammes, hence, 32 + 
18 = 50, therefore, 89 — 50 = 39, which divided 
by 4 gives us 9.75 grammes, as the daily elimi- 
nation of phosphoric acid in this case. This 
condition is known as phosphaturia or phos- 
phatic diabetes, and as much as 8, 10, or 12 
grammes of phosphoric acid passes away in the 
twenty-four hours. Urines of this class 
resemble closely diabetes mellitus : high 
specific gravity ; usually a normal quantity of 
water ; acid reaction, and an excessive or nor- 
mal quantity of urea. Should, then, a urine 
show these characteristics, and the approximate 
quantitative test for phosphates, as just 
explained, show their excessive amount, an 
accurate gravimetric determination of the 
phosphoric acid should be made. To this end 
measure out 50 c.c. of clear urine ; if albumen 
is present precipitate out by nitric acid, and 
take filtrate. Supposing, therefore, we have 
50 c.c. of clear urine, add to it 50 c.c. of strong 
sulphuric acid and 100 c.c. of water, boil in a 
beaker for a few minutes and then add a tea- 
spoonful of the nitrate of ammonia (in crystals) ; 
while still hot add a nitric acid solution of 



ABNORMAL CHEMICAL COMPOSITION. 37 

molybdate of ammonia, adding this in excess ; 
stir well, boil a few minutes, and cast on a 
tarred (weighed) filter paper. Wash yellow 
precipitate two or three times with molybdate 
of ammonia solution; dry at 21 2° F. in a 
steam oven, and weigh precipitate and paper, 
deduct weight of latter from former (precipitate 
and paper), and the result will give the weight 
of the precipitate of the phospho-molybdate of 
ammonia; this now multiplied by 3.142 gives 
the equivalent quantity of phosphoric acid, 
which in our case represents the quantity in 
50 c.c. of urine. To find, therefore, the 
quantity passed in the twenty-four hours is but a 
simple calculation ; for example : — 

Amount of urine passed in the twenty-four 
hours was 2000 c.c. 50 c.c. was taken for 
analysis, and the absolute quantity of phos- 
phoric acid (P 2 5 ) in the phospho-molybdate of 
ammonia precipitate was found to be 0.25 
grammes, consequently to arrive at the quan- 
tity passed in twenty-four hours, we say : — 

50 : 0.25 : : 2000 : x 
x = 10.00 grammes (P 2 5 ). 



38 DIAGNOSIS BY THE URINE. 

The nitric acid solution of molybdate of 
ammonia has the following composition : — 

Molybdate of Ammonia, 10 grammes 

Solution Ammonia, specific gravity 960, 40 c.c. 

Strong Nitric Acid, 80 c.c. 

Water, 80 c.c. 

Dissolve the salt in the ammonia by the aid 
of heat, then pour the solution into the nitric 
acid and water, which have been previously 
mixed together. 



CHAPTER IV. 

MORBID PRODUCTS IN THE URINE IN DISEASE. 

ALBUMEN. 

Albumen, which has an approximate compo- 
sition of oxygen, 22 per cent. ; carbon, 53 ; 
nitrogen, 16; hydrogen, 7; sulphur, 2, when 
found in the urine habitually with a diminished 
specific gravity, is an unfailing evidence of 
disease. True, we now and then meet with 
albumen in the urine of those in health; even 
here, however, its appearance is only occasional, 
its quantity small, and never attended with 
habitual diminished specific gravity, as is the 
case in organic disease of the kidneys : this 
consideration, then, of the specific gravity 
becomes, when albumen is present, and even 
when not, an all-important factor in making 
a differential diagnosis. The detection of albu- 
men is easily made by means of nitric acid 
or picric acid. To this end proceed as follows : 
Take one ounce of the clear urine (if not, filter 

39 



4-0 DIAGNOSIS BY THE URINE. 

first), place in a test glass, pour gently from a 
bottle one drachm and a half of strong clear 
nitric acid, allow the same to flow down the side 
of the glass on to the urine ; as its specific 
gravity is greater than that of the urine, it falls 
to the bottom of the glass, and if albumen be 
present in small quantities, a light haze zone is 
observed just where the layers of acid and 
urine come together. To make sure that this 
is albumen and not urates, which, if in great 
quantities, might give somewhat the same 
appearance from the formation of nitrate of 
urea, mix thoroughly the acid and urine 
together, take out 3 drachms, boil in a test tube, 
and if albumen be present a precipitate is 
immediately formed, whose density is in pro- 
portion to the quantities of albumen present. 
If picric acid is used, proceed in the same man- 
ner, using a saturated aqueous solution of the 
same. The results obtained by this process 
are the same as in the case of nitric acid. It 
possibly, however, is a little more delicate, and 
shows on being boiled with urine the presence 
of any form of albumen, whether it be in the 
form of serum albumen or else one of the 
derived varieties. 



MORBID PRODUCTS IN DISEASE. 4 1 

I may call attention here to what I made 
several years ago the subject of an article in 
the New York Medical Jotirnal, that frequently 
nitric acid, and even picric, when applied in the 
ordinary way, failed to detect very small quan- 
tities of albumen, but that if after boiling the 
urines in a test tube it was suddenly plunged 
into cold water, an appreciable show of albumen 
was seen. This I have, since writing that arti- 
cle, found to take place more frequently in 
interstitial nephritis than I then thought, 
• and I am now sure that many times _ 
when in these cases the urine is reported 
as having no albumen, it is due to the 
cause I have here indicated. 

The volumetric determination of albu- 
men is made as follows, using one of 
Esbach's albumenometers ; Esbach's so- 
lution is also to be recommended as the 
precipitant, and is made by taking 20 
grammes of citric acid, 10 grammes of 
picric acid, dissolving them in 900 
c.c. of hot water and making up to aSSmen- 

OMETER. 

IOOO C.C. 

For analysis, fill the albumenometer up to U 
(mark designated on each tube) with urine, 



42 DIAGNOSIS BY THE URINE. 

then fill to the mark R with the test solution, 
place rubber cork or thumb over the top of the 
tube and tilt and raise again several times (do 
not shake) ; close the tube with a cork and 
leave for twelve or eighteen hours. The lines 
graduated on each albumenometer represent 
the number of grammes in the iooo c.c. of 
urine under examination, consequently the line 
to which the precipitate extends marks at once 
the quantity of albumen in iooo c.c; for exam- 
ple, precipitate extended to line marked 3 and 
patient passed 1200 c.c. in twenty-four hours, 
hence — 

iooo : 1200 : : 3 : x 
x = 3.6 grammes. 

The points necessary to note in the conduc- 
tion of this process are : 1. That the urine to be 
examined is acid; if not, make so with a few 
drops of acetic acid ; 2. If great quantities of 
albumen are present, dilute with one or two 
volumes of water ; of course, the dilution must 
be taken into account in making the final cal- 
culations. 



MORBID PRODUCTS IN DISEASE. 43 

SUGAR. 

The presence of very small quantities of 
suear in the urine constitutes a condition known 
as glycosuria, whereas if large quantities are 
found, it is called diabetes mellitus. The former 
condition, if habitual, is unnatural, and will, if 
allowed to run on, eventuate in the more for- 
midable complaint. These diseased conditions 
of the system by no means point to diseases of 
the kidneys or urinary organs, but really to 
disease of the liver, or rather perverted action 
therein. Sometimes, also, a diet too exclusively 
saccharine or starchy in its character will bring 
about this condition of things in those suscepti- 
ble to this malady. The kidney, in ridding 
itself of this morbid product, becomes irritated, 
and this irritation extends down the entire canal, 
and we thus have produced a real polyuria. 
There are three distinct varieties of this disease 
as regards grade and prognosis. In the first 
class we have a urine of high specific gravity, 
1.030 or more, large increase of water, and an 
increase of all the other solids. In the second 
class a urine of even higher specific gravity, 
1.030 to 1.060, no increase, but often diminished 
volume of water, and an increase of all the 
4 



44 DIAGNOSIS BY THE URINE. 

other solids, constituting thus a true baruria. 
In the third class of cases the urine appears 
about normal in quantity, a little high in specific 
gravity, 1.025 to I -030, and a small quantity of 
sugar." In all cases the urine is decidedly acid, 
and undergoes, after standing a short while, 
putrid (alkaline) decomposition ; it is also 
generally turbid, from the detritus of the urinary 
organs brought about by the irritating action 
of sugar on the mucous membranes. 

All forms of this disease are grave, but the 
first two varieties are the most formidable to 
treat, and nearly always in the young eventuate 
in an early grave. The test for sugar in the 
urine is made and applied as follows: — 

Picric acid test ; this affords an extremely 
simple and delicate test for sugar (glucose) in 
the urine, and has the additional advantage of 
showing at the same time if albumen is present; 
its reaction with sugar is also not interfered 
with by the presence of albumen. Take 2 
drachms of urine and add to it an equal quan- 
tity of a saturated aqueous solution of picric 
acid, add 2cfew drops of caustic potash solution 
making alkaline and apply heat gently ; the 
color changes to a deep red or mahogany 



MORBID PRODUCTS IN DISEASE. 45 

brown, and is not to be confounded with the 
bright cherry-red which occurs in any urine 
when treated in this way. 

2. Heller's test. Take a test tube and place 
in it 2 drachms of urine; if albumen is present, 
first rid the urine of it by means of heat; if, 
also, the color of the urine is dark, which, how- 
ever, is hardly ever the case in diabetic urines, 
treat first the urine with a little lead acetate 
solution, filter the urine thus freed of its color 
and take then, as said, 2 drachms, add to this 
1 drachm of caustic soda or caustic potash 
solution, and boil ; on so doing the earthy phos- 
phates precipitate out, and if they are in large 
quantities they must be filtered out ; if not, their 
presence is disregarded. The color of the 
urine, if sugar be present, changes to a lemon- 
yellow, yellowish -brown, or blackish -brown, 
according to the quantity of sugar present. 
Add now a few drops of nitric acid, the dark 
color vanishes, and in its place gives off the 
odor of burnt surar. 

The gravimetric determination of sugar is 
effected by the use of Fehling's solution, and 
depends for its reaction upon the power of glu- 
cose to reduce, in alkaline solutions, cupric salts 



4 6 



DIAGNOSIS BY THE URINE. 
Fig. 5. 




Graduated Burette. 



MORBID PRODUCTS IN DISEASE. 47 

to cuprous, or suboxide of copper. If the urine is 
clear and free of albumen, measure out carefully 
10 c.c. ; if it is not, get rid of the albumen by 
heat, filter, and then measure carefully 10 c.c. 
To this add 190 c.c of distilled water and fill 
a burette with the same. Carefully measure out 
10 c.c. of Fehling's solution, place in a porcelain 
basin, add 40 or 50 c.c. of distilled water and 
apply heat gently. Into this run from the burette 
carefully, drop by drop, the diluted urine, and 
on so doing the blue solution will become tur- 
bid, gradually losing its color, and in its place 
will appear yellow, red, and finally a colorless 
solution. When this is attained it is evident 
that complete reduction has been effected ; to 
make sure, however, take a few drops of the 
supernatant fluid from the porcelain basin, place 
in test tube, and add a few drops of acetic acid 
and then a little ferrocyanide of potassium 
(solution); if no brown coloration ensues, the 
process is completed ; if, on the contrary, you 
get this reaction, continue to run in the urine 
from burette, drop by drop, and test until the 
reaction with the ferrocyanide shows no change 
in color. To calculate result, get total quantity 
of urine passed in twenty-four hours, expressed 



48 DIAGNOSIS BY THE URINE. 

in cubic centimetres, divide this by the number 
of cubic centimetres run from the burette, and 
the quotient will be the amount of sugar 
excreted in twenty-four hours, expressed in 
grammes. 

COMPOSITION OF FEHLING'S SOLUTION. 

Cupric Sulphate, 34.64 grammes 

Sodium and Potassium Tartrate, 173 

Sodium Hydrate, 60 " 

Distilled Water, . . to ... 1000 c.c. 
10 c.c. of this solution are reduced by 0.05 gramme of sugar. 



COLORING MATTERS — LEUCINE AND TYRO- 
SINE, BLOOD AND PUS. 

Abnormal coloring matters appear at times 
in the urine, but with the single exception of 
that derived from blood do not indicate any 
special form of kidney or urinary disease. 

Bile, when found in the urine, indicates 
hepatic and portal congestions, and gives to it a 
brown or greenish-yellow color. Biliary acids 
with Leucine and Tyrosine indicate organic dis- 
ease of the liver, generally acute yellow atro- 
phy. Bile is detected in following manner : To 
ten cubic centimetres of urine are added 3 or 



MORBID PRODUCTS IN DISEASE. 



49 



4 c.c. of a solution of caustic potash of exact 
composition, i part of potassa to 3 of water, 
shake, and to it add an excess of hydrochloric 
acid ; if bile be present, the urine assumes a 
beautiful emerald-green color. 

Fig. 6. 




:. fa > ;V j 

5Sf- - ' J ,; >: : ;' '..\ -'f\ ".V 'V '/ 



a a, Leucine Balls. £ £, Tyrosine Sheaves, c, Double Balls of Ammo- 
nium Urate. 

Biliary acids are seldom found in any appre- 
ciable quantities, and as their detection is diffi- 
cult and the pathological processes which cause 
them to appear are the same as those causing 
the appearance of leucine and tyrosine, I will 



50 DIAGNOSIS BY THE URINE. 

mention the tests for these latter only. 50 cubic 
centimetres of urine are taken and evaporated 
to a small bulk ; if leucine and tyrosine are 
present, they will crystallize out and may be 
examined under the microscope, leucine appear- 
ing as oily, circular discs floating on the water, 
and tyrosine as long, prismatic needles ; should 
the urine contain albumen, it must be first rid 
of this by using as the precipitant a solution of 
lead acetate, which again must be eliminated by 
passing sulphuretted hydrogen through it and 
the filtrate finally from the lead sulphide thus 
formed is used for evaporation. 

BLOOD. 

Blood appears in the urine under various 
pathological conditions of the system, but from 
a clinical chemical standpoint we will consider 
but two conditions in which it constitutes dis- 
ease of the urinary organs : First, when blood 
globules or corpuscles are found; and secondly, 
when only the coloring matter is present. The 
first condition is called hematuria and the sec- 
ond haematinuria. Blood may either come from 
the kidneys or else from the bladder, and to 
make a differential diagnosis we must consider 



MORBID PRODUCTS IN DISEASE. 



51 



the reaction, blood coagula, specific gravity, and 
microscope. Hemorrhage from the kidney is 
generally acid ; from the bladder alkaline. 
When this alkalinity is due to the presence of 
carbonate of ammonia, it is then quite certain 
the hemorrhage was from the bladder. Dark 



Fig. 7. 






&e • 



%% 



© @« 



aft 



V 



f 



Colored and Colorless Blood 
Corpuscles of Various Forms. 




• • • * % 

Shriveled Blood Corpuscles in 
Urine (Catarkh of the Blad- 
der) with Numerous Lymph Cor- 
puscles and Crystals of Triple 
Phosphate. 



brown or red-brown hemorrhages point to the 
kidneys as the diseased organs, whereas bright 
red would indicate the bladder; smoky, also, to 
dark brown urine points to lesions in the kid- 
ney. Soft clots, fresh and bright, are generally 
found in kidney hemorrhage, whereas hard, 
yellow, and sometimes colorless clots point to 



52 DIAGNOSIS BY THE URINE. 

the bladder as die source of trouble. Again, 
long and rod-shaped clots indicate hemorrhage 
from the kidney, whereas large and irregular 
masses are most probably from the bladder. 
In regard to the specific gravity, we generally 
find in kidney hemorrhage a condition of poly- 
uria ; in hemorrhage from the bladder no poly- 
uria. Under the microscope, if the hemorrhage 
be from the kidney, we will find blood-tinged 
kidney epithelium, and if from the bladder, 
epithelium corresponding to the same. For 
the special diseases causing this pathological 
change in the urine, the reader is referred to 
special works on this subject, as the scope of 
this treatise does not permit of my so doing. 
The detection of blood in urine is determined 
either by aid of the microscope, by which we 
can identify the corpuscles, or else by the fol- 
lowing chemical tests : — 

Giiaiaciim Test. — Mix one c.c. of freshly pre- 
pared tincture of guaiacum with the same quan- 
tity of old oil of turpentine or ozonized ether. 
Take 2 drachms of the urine in a test glass, 
pour the guaiacum and turpentine upon the 
urine ; if blood be present, between the resin- 
ous mass which precipitates out and the clear 



MORBID PRODUCTS IN DISEASE. 53 

turpentine solution a tinge of blue will appear, 
depth of color depending upon quantity of 
blood present ; shake up the mass and it will 
form a blue emulsion. Although this test will 
answer in the majority of cases, it is always 
w r ell to strengthen it with the one I will now 
give, which is scientifically accurate but a little 
more troublesome to execute. 

Hczmin Test. — When corpuscles are not 
found in the urine, but simply coloring matter, 
apply this test. Take 3 drachms of the red urine, 
boil with a concentrated solution of caustic 
potash, take phosphatic precipitate which comes 
down with the blood coloring matter (tinged 
red), dry, and mix with a few grains of pure 
chloride of sodium, place on watch glass, add 
to it one or two drops of glacial acetic acid, 
placing in the mixture a strand of hair ; after 
some while haemin crystals crystallize out on 
the hair, and may be identified by means of a 
microscope. 

PUS. 

Pus in the urine is always the sign of inflam- 
mation, either of the kidneys or else of the 
bladder and urinary tract. Urines containing 
pus are generally alkaline, and always so when 



54 



DIAGNOSIS BY THE URINE. 
Fig. 9. 







* 



H^min Crystals. 
1. Human. 2. Seal. 3. Calf. 4. Pig. 5. Lamb. 6. Pike. 7. Rabbit. 




Deposit in Ammoniacal Urine (Alkaline Fermentation). 
a. Acid Ammonium Urate, b. Ammonio-magnesium Phosphate, c. Bacterium 

Ureae. 



MORBID PRODUCTS IN DISEASE. 55 

the inflammation is from the bladder ; when, on 
the other hand, pus is found in an acid urine 
recently passed, it is an indication that the inflam- 
mation is either of the kidney or else of the 
ureters. Albumen is also found in these cases, 
but in small quantity. Again, if the pus is 
from disease of the bladder, the specific gravity 
of the urine is normal or else a little above 
normal. Urines containing pus in large quan- 
tities are thick, stringy, and contain much sedi- 
ment ; the sediment may be alone composed of 
pus, or else urates, epithelium, pus, and blood 
globules. To differentiate these conditions, 
apply tests already given for blood, urates, and 
uric acid ; examine epithelium deposit under 
microscope and apply following special test for 
pus : To the sediment add a solid piece of 
caustic soda or caustic potash ; it will lose its 
color and gradually become a stringy, vitreous, 
and cohesive lump if the pus is in large quan- 
tity ; in small quantities, however, the mass 
dissolves up and leaves a fluid which is only 
stringy and vitreous. 



CHAPTER V. 

MORBID PRODUCTS WHICH ARE PROPERLY CLAS- 
SIFIED AS URINARY SEDIMENTS AND 
URINARY CALCULI. 

URINARY SEDIMENTS. 

Organized and unorganized sediments are 
found in the urine; the former when present 
constitute disease, the latter only when in 
abnormal amounts. Tube casts, blood cor- 
puscles, epithelium cells, and spermatozoids are 
organized ; uric acid, urates, phosphates, and 
oxalates unorganized. Uric acid is generally 
in lozenge-shape crystals, urates indistinctly 
crystalline, phosphates generally in distinct 
prismatic crystals, and oxalates in small octa- 
hedra or dumb bells. 

Urinary calculi are usually composed of 
either uric acid and urates of sodium, potas- 
sium, and calcium, or else of phosphates and 
oxalates of calcium ; xanthine and cystine are 
only occasionally found. To test these calculi, 

56 



URINARY SEDIMENTS AND CALCULI. 57 

pulverize and place a small portion on platinum 
foil and heat over the Bunsen flame. 

1. If no residue is left, it is either uric acid, 
ammonium urate, xanthine, or cystine. To 
determine this, take small portion, place on 
watch glass, add few drops dilute nitric acid, 
and heat to dryness ; add to this a few drops of 

Fig. 11. 




Acid Ammonium Urate. 



ammonia, and if mass changes to beautiful 
purple color (Murexide test), sediment is either 
uric acid or urate of ammonia ; if no change of 
color, the substance is xanthine or cystine. To 
determine this, take portion of original pulver- 
ized calculus and dissolve in nitric acid on 
watch glass ; if solution turns yellow on evap- 
oration, and leaves a residue insoluble in 
potassium carbonate, the calculus is xanthine ; 
should the solution, however, turn brown, and 



58 



DIAGNOSIS BY THE URINE. 



leave a residue soluble in ammonia, it is 
cystine. 



Fig. 12. 




A. Crystals of Cystin. B. Oxalate of Lime 

Fig. 13. 



a 




H 



Oxalate of Lime. 
a. b. Octahedra. c. Compound Forms, d. Dumb Bells. 

2. If on heating the pulverized calculus on 
platinum foil a residue is left, the calculus is 



URINARY SEDIMENTS AND CALCULI. 59 

either a urate of calcium or else an oxalate or 
phosphate of the same. To determine this, 
dissolve the substance in hydrochloric acid (on 
a watch glass) ; if it effervesces, the calculus is 
either a urate or oxalate. If the murexide test 
gives a negative result, why then it is an 
oxalate. If on adding hydrochloric acid, solu- 
tion is attained without effervescence, the cal- 
culus is a phosphate, which may be further 
verified by adding to the solution a few drops 
of nitric acid solution of molybdate of ammo- 
nia, when a canary-yellow precipitate imme- 
diately forms. 

Calculi, when occurring in the urine, although 
indicating no direct disease of the kidneys and 
urinary apparatus, do indicate, by the particular 
kind, the special diathesis which is being estab- 
lished in the system, and which in due course 
of time will eventuate in disease of the urinary 
organs. Sediments, too, which precipitate out 
immediately or a short while after voiding the 
urine, indicate a strong tendency to the forma- 
tion of concretions. 



CHAPTER VI. 

RESUME. 

THE DIAGNOSIS OF DISEASES OF THE KIDNEY 
AND URINARY ORGANS. 

All forms of kidney degeneration are due to 
one of three causes : — 

i. Hyperaemia, which when active is called 
acute congestion, and when passive chronic 
congestion. 

2. Irritation ; this is almost always active in 
its character, and sooner or later eventuates in 
inflammation, or else, taking a more chronic or 
sub-acute course, brings about those pathologi- 
cal changes which are termed capillary arterio- 
fibrosis. 

3. Inflammation; this, too, is either of an 
acute and active form, or else of a more 
chronic and sub-acute character. The causes 
or class of causes which bring about this con- 
dition of things are either direct or indirect, the 
first class inducing active inflammation and the 

60 



RESUME. 6 1 

second an inflammation of a more chronic 
course. 

To differentiate these several phases of kid- 
ney disease requires, at times, a good deal of 
well directed patience and perseverance. Im- 
portant is it, however, for on the right apprecia- 
tion of the case not only depends a proper 
prognosis, but at times the very life of the 
patient itself. 

Hyperemia, whether active or passive, is not 
in itself a disease of the kidneys, but simply 
the expression of a condition which, unrelieved, 
will eventuate in disease. The appearance of 
and morbid anatomy of the kidneys undergoing 
this process, is important to us only as a 
pathological study for future information. The 
appearance and character of the urine passed 
during this period, on the other hand, is of 
great practical use and importance, as it can be 
gathered during life, whereas the pathological 
study begins only when life is extinct. The 
differential diagnosis between active and passive 
congestion is made as follows : — 

In active congestion we have a complaint 
coming on suddenly ; in passive coming on 
gradually. In active congestion the arterial 



62 DIAGNOSIS BY THE URINE. 

system is in a high state of tension ; in passive 
the tension is low. In active the urine is sud- 
denly decreased in quantity or else normal, 
specific gravity normal, and little or no albumen ; 
in passive the urine will be observed to have 
decreased from day to day, to contain more 
albumen, to have increased in specific gravity 
and depth of color, and to have on standing a 
decided sediment of the salts which precipitate 
out from the diminished volume of water. If 
this condition be allowed to continue very long, 
albumen increases to great quantities in the 
urine, and with it the patient becomes anasar- 
cous ; if the cause of the venous stasis cannot 
be removed, the case rapidly goes into nephritis 
of a chronic character. The time at which this 
change takes place is always marked by a 
decrease of specific gravity (under 1.018), and 
the appearance generally of granular and tube 
casts. Should active hyperemia run on uncon- 
trolled, the case is more apt to run into one of 
acute nephritis. 

The direct causes of active hyperaemia are 
usually sudden variations between the surface 
and central temperatures of the body, brought 
about by chilling the body in various ways. 



RESUME. 63 

Passive hyperemia, or renal stasis, is due to 
obstructive causes, such as occur in heart, lung, 
and liver diseases, chronic peritonitis with effu- 
sion, hydatid tumors, pregnancy, and, in fine, to 
all sources which obstruct the direct, or else the 
return, blood supply of the kidneys. In both 
forms of hyperemia the temperature of the 
body is not increased unless some intercurrent 
affection is also present. I may finally add 
that as a further means of diagnosing these two 
conditions, the effect of diuretics and arterial 
tonics and sedatives may be made use of 

In active congestion, diuretics and arterial 
tonics which owe their diuretic action to an 
increasing of the tension of the blood, are 
pernicious, whereas sedatives or diuretics 
which increase the flow of urine by simply 
increasing the transudation of water, are bene- 
ficial. In passive congestion, digitalis, spar- 
teine, and caffeine act with efficiency and 
promptness, and lose only their effect when the 
obstruction which causes the stasis is permanent 
and increasing. 



64 DIAGNOSIS BY THE URINE. 

PARENCHYMATOUS NEPHRITIS. 

Whether or not this pathological condition 
of the kidneys is brought about by irritation or 
inflammation, preceded or not by acute or 
passive congestion, we recognize but two kinds, 
acute and chronic ; and again of the acute two 
varieties: I. Ordinary catarrh of the tubules 
of the kidney, similar to an ordinary catarrh 
of the bronchial tubes ; 2. A more severe form 
of catarrh of the urine tubes, characterized by 
a profuse exudative secretion ; this is known as 
diffuse or croupous nephritis (acute Bright's 
disease), and would correspond, taking the 
comparison above, to a severe pneumonitis. 
The differential diagnosis is made as follows : — 

In acute catarrhal nephritis we have little or 
no fever, slight bearing and dragging pains in 
the sacral region, small show, and sometimes 
none at all, of albumen, normal or slightly 
diminished quantity of urine, specific gravity 
normal,' reaction acid, usually decided sedi- 
ment but composed mainly of mucus ; no 
oedema or anasarca. 

In acute diffuse nephritis we have considera- 
ble fever, greater feeling of discomfort in sacral 
region, great oedema, and sometimes anasarca 



RESUME. 65 

so great as to completely disfigure the indi- 
vidual ; large quantities of albumen in the 
urine, increased specific gravity, and marked 
diminution in quantity of water (often only 
200 c.c. in twenty-four hours) ; large sedimen- 
tary deposits, composed mainly of urates, blood 
coloring matters, and epithelium cells. 



CHRONIC PARENCHYMATOUS NEPHRITIS. 

Chronic parenchymatous nephritis may be 
the sequel of an acute attack, but oftener 
begins as such. The first symptom of this 
disease is dropsy without fever : the specific 
gravity of the urine is always found below nor- 
mal, and has a range generally of between 
1. 01 3 and 1. 01 7. When the specific gravity 
falls below this, and shows a lower limit of 
1.010 or 1. 01 2, it is an evidence that the 
nephritis is taking on what may be termed a 
secondary action, and is going to become an 
interstitial variety. The quantity of urine 
passed is generally normal, its reaction decidedly 
acid, and its color is generally pale yellow. It 
contains much detritus frequently, consisting of 



66 DIAGNOSIS BY THE URINE. 

epithelium of the kidney and various cell 
forms ; albumen is always found in considerable 
quantities, ranging from ^ to 2^ per cent. 



INTERSTITIAL NEPHRITIS. 

This disease of the kidneys is frequently a 
natural consequence of the chronic secondary 
parenchymatous variety; when it is, the general 
characteristics are somewhat masked, as the 
change has been gradual. The great differ- 
ence, however, shown in the urine is in the less 
quantity of albumen, the increased volume, 
paler color, and specific gravity ranging lower, 
1.008 to 0.012. After a little we note the 
fibrous change the vascular system has under- 
gone, and see developed a true capillary 
arterio-fibrosis, evidenced by a full, tense pulse, 
associated with hypertrophy of the heart, most 
apparent on the left side. Interstitial nephritis, 
or cirrhosis of the kidney, seldom starts in 
youth, but most often about the middle of life, 
and without dropsy. For a long time there is 
really nothing to call attention to the disease 
save the condition of the heart and pulse. If, 



RESUME. 67 

however, together with this indication we find 
small (yes, sometimes very small, and for days 
at a time none) quantities of albumen, impair- 
ment of vision, diminished specific gravity, and 
a pale colored urine of normal quantity or else 
increased, we can safely pronounce the case as 
one of atrophy of the kidneys. It is particu- 
larly important in these cases to estimate the 
urea from time to time, as a means of better 
forming a diagnosis and prognosis. 

As the disease advances, although the volume 
of water increases, the urea falls off, and towards 
the end seldom shows more than 7 or 8 grammes 
for the twenty-four hours. The reaction of the 
urine in this variety of kidney disease is acid, 
and only becomes neutral and alkaline when the 
nephritis is of the suppurative variety ; when 
of this latter kind, the odor of the urine is 
putrid, and it contains blood-coloring matters 
and ptcs. 

The differential diagnosis between interstitial 
nephritis and amyloid kidney is extremely 
difficult, as the general characteristics of the 
urine are about the same. Amyloid kidney, 
however, has no symptoms of capillary arterio- 
fibrosis, and is generally associated with some 



68 DIAGNOSIS BY THE URINE. 

constitutional disease, such as chronic tubercu- 
losis, scrofula, malarial cachexia, and syphilis, 
and is frequently accompanied with a certain 
amount of dropsy. 



PYELITIS AND CYSTITIS. 

Inflammation of the pelvis of the kidney and 
of the ureters and bladder frequently occur. 
Though much has been written in regard to the 
differential diagnosis of these conditions, it is of 
no real practical utility, since a cystitis will, if 
not cured, set up inflammation higher up the 
canal, and vice versa. For clinical practical 
purposes, therefore, I will disregard much of 
this, and will say that when the pelvis of the 
kidney and the ureters are alone affected, it is 
called pyelitis ; when, however, the inflamma- 
tion extends to the bladder, it is called cystitis. 
If the pelvis of the kidney is the principal seat 
of inflammation, it is designated as cysto- 
pyelitis ; if, on the other hand, the bladder, it is 
called pyelo-cystitis. These inflammations may 
be acute or chronic, but in all we find pus. A 
differential diagnosis is approximately made as 
follows ; — 



RESUMfe. 69 

Acute and chronic inflammations of the pelvis 
of the kidney and ureters are attended with 
acid urines, albumen and pus; acute inflamma- 
tions of the bladder with neutral or alkaline 
urine, pus, but no albumen. 

Inflammation of the pelvis and ureters are 
accompanied by polyuria; inflammation of the 
bladder never. Specific gravity in pyelitis is 
generally below normal ; specific gravity in 
cystitis normal or above. No particular fre- 
quency in making water in pyelitis ; constant 
desire to pass water in cystitis. Besides these 
differential points, the microscope may be used 
for the identification of renal or else of bladder 
epithelium, as the case may be. 

Should the cystitis, as is sometimes the case, 
be very severe, we will then find not only pus 
but albumen in the urine. To differentiate this 
from pyelitis, we must refer to the specific 
gravity and reaction : In pyelitis it is generally 
below normal, and reaction acid ox just neutral ; 
in cystitis (severe), specific gravity is normal 
or above, and reaction intensely alkaline, due to 
presence of ammonia carbonate, and occasionally 
to ammonium sulphide. In doubtful cases the 
urine must be drawn for examination, by means 



JO DIAGNOSIS BY THE URINE. 

of a rubber catheter, directly from the kidney, 
guttatim.* 

Apparatus required for executing all the tests contained 
in this volume : — 

i. Test tubes, one dozen. 

2. Small funnels — y 2 oz., 6; 4 oz., 6. 

3. Glass rods, different sizes, 6. 

4. Watch glasses, 6. 

5. One nest of beakers. 

6. One wash bottle, 12 oz., for water. 

7. Porcelain evaporating dishes, 6. 

8. Small conical test glasses, 6. 

9. Water bath. 

10. Spirit lamp. 

11. Small piece platinum foil. 

12. One pair of pincers. 

13. Small chemical balance (only necessary, however, if 

gravimetric estimations are to be made). 

14. One urinometer float (with temp, chart). 

15. Microscope with appurtenances. 

16. One Esbach's albumenometer. 

17. One Doremus' ureometer. 

18. One Mohr's burette, 50 c.c, graduated in tenths. 

* In all urine examinations, the entire quantity for twenty- 
four hours should be known and a portion of this taken for 
analysis. In case this provision cannot be carried out, the 
urine passed on rising in the morning will give the best 
approximate results. One gramme is equivalent to 15.44 
grains ; 30 cubic centimetres is equivalent to one ounce. 



RESUME. 7 1 

19. Two sizes cut filter paper for funnels, as stated. 

20. Blue and red litmus paper. 
91. One litre flask. 

22. One 200 c.c. flask. 

23. One 10 c.c. pipette. 

24. One measuring jar for measuring urine, to hold 90 c.c. 

and graduated in -^ c.c. divisions. 

25. One-half dozen flasks, sizes 4 and 6 ounces. 

26. Small quantity assorted glass tubing. - 

27. Three or four feet India rubber tubing. 

28. One pipette, to deliver 5 c.c. 

29. One-eighth gross assorted corks. 

30. Filter stand, test-rack stand, and ring stand. 

Chemicals required for executing all the tests in this 
volume : — 

1. Water, distilled, or very pure rain water. 

2. Alcohol, methylated, for lamp. 

3. Old oil of turpentine. 

4. Ozonized ether. 

5. C. P. hydrochloric acid. 

6. C. P. sulphuric acid. 

7. Picric acid. 

8. Glacial acetic acid. 

9. Ordinary acetic acid. 

10. Potassa and soda in sticks. 

11. Potassa in solution (strength, 1 part to 3 parts H 2 0). 

12. Rochelle salts. 

13. Cupric sulphate. 

14. Ammonia molybdate. 



J 2 DIAGNOSIS BY THE URINE. 

15. Silver nitrate solution (1 part of AgN0 3 to 8 of 

water). 

16. Citric acid. 

17. Ammonia. 

18. Lead acetate solution (1 to 8 of water). 

19. Sodium hyposulphite. 

20. Ammonium nitrate. 

21. Solution of bromine. 

22. Ferrous sulphide. 

23. Potassium ferro-cyanide. 

24. Freshly prepared tincture of guaiacum. 

25. C. P. sodium chloride. 

26. C. P. nitric acid. 

The reagents used, unless stated otherwise, are solutions 
in water (1 to 15). 



Fig. 14. 



resume:. 

Fig. 15. Fig. 16. 







Coarsely Granu- 
lar Casts. 



Acid Sodic Urate Leucocyte 
in Cylinders. Cast. 



73 



Fig. 17. 




Blood Cast. 



Fig. 18. 



Fig. 19. 




Hyaline Casts. 





74 



DIAGNOSIS BY THE URINE. 



Fig. 20. 



Fig. 21. 



Fig. 22. 



IfM 


li^^llil 


h.vi 


B§p' t S§§|j§J 


m 




E : '$k 


fevi'v^'j 


Wffl 


fe^-si 








H 


§ % 


fewlf 








W&$3 


H§&? 


^§? 


NELY 


Granular 


c 


!yst. 






& 



*g$«nl 



Peculiar Changes Crenated Red 

of the Red Blood Blood Corpuscles 

Corpuscles in in Renal H^ma- 
hematuria. turia. 



d - 




Deposit in Acid Fermentation of Urine. 
a. Fungus, b. Amorphous Sodium Urate, c. Uric Acid. d. Calcium Oxalate. 



INDEX. 



Acetic acid, 47 
Acidity of urine, 15 
Acute nephritis, 62 
Albumen, composition of, 39 
detection of in urine, 39 
by picric acid, 40 
by nitric acid, 40 
volumetric determination of, 

41 

by Esbach's albumeno- 
meter, 41 
Albumen in urine, 28 
Alkaline phosphates, 35 

urine, 21, 22 
Ammonia carbonate, 69 
Ammonium sulphide, 69 
Amount of urine in disease, 16 
Amyloid kidney, 67 
Anuria, 16 

Atrophy of kidneys, 19, 67 
Apparatus, 70-72 
Average composition of urine, 9 

quantity of urine in health, 
11 

Baruria, 44 
Bile in urine, 48 

to detect, 48 
Biliary acids, 49 
Blood in urine, 50 

differential diagnosis of, 50 

detection of, 52 

guaiacum test for, 52 

haemin test, 53 

corpuscles, 56 
6 



Brick-dust deposit, 56 

Caffeine, 63 

Calcium, 30, 59 

Capillary arterio-fibrosis, 60 

Carbonate of ammonia, 22 

Chloride of sodium passed, 23 

Chlorides, 33 

to determine quantity, 34 
Chronic parenchymatous nephritis, 

65 

interstitial, 65 

symptoms of, 65 
Chyluria, 18 
Cirrhosis of kidney, 66 
Color of normal urine, 14 
Coloring matters of urine, 48 

bile, 48 

blood, 48 

leucine, 48 

tyrosine, 48 
Conditions governing excretion of 

urea, 24 
Congestion of kidneys, 61 

active, 61 

differential diagnosis of, 61 

passive, 61 
Consistence of urine, 14 
Constituents of urine in disease, 

10, 16 
Cuprous, 45 
Cupric salts, 45 
Cystine,* 56 
Cystitis, 68 
Cysto-.pyelitis, 65 



75 



7 6 



INDEX. 



Deviations in color of urine, 18 

in composition of urine in 
disease, 24 
Digitalis, 63 
Diabetes, 16 

insipidus, 17 

mellitus, 17, 18, 36, 43 

phosphatic, 36 

Earthy phosphates, 35 
Estimation of urea, 26 

Fehling's solution, 45, 47 

composition of, 48 
Ferrocyanide of potassium, 47 
Fixed alkali, 22 
Forms of uric acid, 31 

Glycosuria, 43 
Gout diathesis, 31 
Graduated burette, 46 
Guaiacum, 52 

Haematinuria, 50 
Hematuria, 50 
Hcemin, 53 
Hemorrhage, kidney, 51 

bladder, 51 
Hydrate solution, 28 
Hydruria, 16 
Hyperemia, 60, 61 

active, 62 

passive, 63 

means of diagnosing, 63 
Hypobromite of soda, action of, 

26, 29 
Hyposulphite of sodium, 21 

Inflammation of kidneys, 60, 69 

pelvis, 69 

ureters, 69 
Interstitial nephritis, 66 
Irritation of kidneys, 60 



Kidney degeneration, forms of, 

60 
Kidneys, evidence of disease in, 25 
Kreatinin, 26 

Leucine, 48 

test for, 50 
Litmus paper, red, 22 

blue, 22 
Liver, evidence of disease in, 25 

Molybdate of ammonia, 37, 59 

nitric acid solution of, 38 
Murexide test, 32, 57 

Nephritis, 30, 3^ 62 

acute, 62 

acute catarrhal, 64 

diffuse, 64 

parenchymatous, 64 
Nitrate of ammonia, 36 
Nitrogen in urine, 29 
Normal urine, 14 

Odor of urine, 15, 20 
Oliguria, 16 

Parenchymatous nephritis, 64 
Phosphates, alkaline, 36 

earthy, 35 
Phosphatic diabetes, 18, 36 
Phosphaturia, 18, 36 
Phosphoric acid, amount passed, 

35 

to determine quantity of, 35 
gravimetric determination of, 
36 

Platinum foil, 58 

Pneumonia, 34 

Polyuria, 16, 43, 69 

Potassium, 30 

Pus in urine, 53 
test for, 55 



INDEX. 



77 



Pyelitis, 6S 
Pyelo-cystitis, 6S 

Quantity of urea excreted, 24, 29 
urine in summer, 1 1 

Reaction of urine, 15, 21 

Sodium, 30 

Sodium, hyposulphite of, 21 

Solids excreted in urine, 13 

Sparteine, 63 

Specific gravity of urine, 12, 17 

Suboxide of copper, 47 

Sugar, 43 

gravimetric determination of, 

45 
Heller's test, 45 
picric acid test, 44 
presence of in urine, 43 
test for in urine, 44 

Temperature of urine, 13 
Transparency of urine, 15, 20 
Tube casts, 56 
Turpentine, 52 
Tyrosine, 48 
test for, 50 

Urates, 26 
Urea, 24 

conditions governing excre- 
tion of, 24, 25 

estimation of, 26 

quantity excreted, 24, 25 
Ureometer, 26 
Uric acid, 21, 26, 30 

to detect, 32 



Urina potus, 16 
Urinary calculi, 56 

murexide test of, 57 

to test, 57 
Urinary organs, disease in, 14 
Urinary sediments, 56 

organized and unorganized, 

56 

Urine, what it is, 9 
alkaline, 21 

average composition of, 99 
average quantity in winter in 

health, II 
chlorides in pathological, 34 
consistence of, 14 
constituents in disease, 10 
deviations in color of, 18 
deviations in composition of 

in disease, 24 
in disease, 16 

amount of, 16 
normal, 14 

acidity of, 15 
color of, 14 
odor of, 15, 20 
reaction of, 15, 21 
transparency of, 15, 20 
solids excreted in, 13 
specific gravity of, 12, 17 
temperature of, 13 
total solids in, 17 
Uroerythrine, 19, 30, 32 

to determine presence of, 32 

Venous stasis, 62 
Volatile alkali (carbonate of am- 
monia), 22 

Xanthine, 56 



CATALOGUE No. 7. MAY, 1892. 



A CATALOGUE 

OF 

Books for Students. 

INCLUDING THE 

? QUIZ-COMPENDS ? 



CONTENTS. 



PAGE 

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Eye Diseases, . . .9 
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PAGE 

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of Medicine at University College Hospital. 

" We wish a copy could be put in the hands of every Student or 
Practitioner in the country. In our estimation, it is the best book 
of the kind ever written."— A''. Y. Medical Journal. 

" Dr. Waring's Therapeutics has long been known as one of the 
most thorough and valuable of medical works. The amount of 
actual intellectual labor it represents is immense. . . . An in- 
dex of diseases, with the remedies appropriate for their treatment, 
closes the volume." — Boston Medical and Surgical Reporter. 

" The plan of this work is an admirable one, and one well calcu- 
lated to meet the wants of busy practitioners. There is a remark- 
able amount of information, accompanied with judicious comments, 
imparted in a concise yet agreeable style." — Medical Record. 

No. 7. MEDICAL JURISPRUDENCE AND 
TOXICOLOGY. 

THIRD REVISED EDITION. 

By John J. Reese, m.d., Professor of Medical Jurispru- 
dence and Toxicology in the University of Pennsyl- 
vania ; President of the Medical Jurisprudence Society 
of Phila. ; Third Edition, Revised and Enlarged. 

" This admirable text-book." — Amer.Jour. of Med. Sciences. 

" We lay this volume aside, after a careful perusal of its pages, 
with the profound impression that it should be in the hands of every 

doctor and lawyer. It fully meets the wants of all students 

He has succeeded in admirably condensing into a handy volume all 
the essential points." — Cincinnati Lancet and Clinic. 

" The book before us will, we think, be found to answer the ex- 
pectations of the student or practitioner seeking a manual of juris- 
prudence, and the call for a second edition is a flattering testimony 
to the value of the author's present effort. The medical portion 
of this volume seems to be uniformly excellent, leaving little for 
adverse criticism. The information on the subject matter treated 
has been carefully compiled, in accordance with recent knowledge. 
The toxicological portion appears specially excellent. Of that por- 
tion of the work treating of the legal relations of the practitioner 
and medical witness, we can express a generally favorable ver- 
dict." — Physician and Surgeon, Ann Arbor, Mich. 

Price of each Book, Cloth. $3.00; Leather, $3.50, 



6 STUDENTS' TEXT-BOOKS AND MANUALS. 

ANATOMY. 

Macalister's Human Anatomy. 816 Illustrations. A new 

Text-book for Students and Practitioners, Systematic and Topo- 
graphical, including the Embryology, Histology and Morphology 
of Man. With special reference to the requirements of 
Practical Surgery and Medicine. With 816 Illustrations, 
400 of which are original. Octavo. Cloth, 7.50; Leather, 8.50 
Ballou's Veterinary Anatomy and Physiology. Illustrated. 
By Wm. R. Ballou, m.d., Professor of Equine Anatomy at New 
York College of Veterinary Surgeons. 29 graphic Illustrations. 
i2mo. Cloth, 1. 00; Interleaved for notes, 1.25 

Holden's Anatomy. A manual of Dissection of the Human 
Body. Fifth Edition. Enlarged, with Marginal References and 
over 200 Illustrations. Octavo. 

Bound in Oilcloth, for the Dissecting Room, $4.50. 
" No student of Anatomy can take up this book without being 
pleased and instructed. Its Diagrams are original, striking and 
suggestive, giving more at a glance than pages of text description. 
* * * The text matches the illustrations in directness of prac- 
tical application and clearness of detail." — New York Medical 
Record. 

Holden's Human Osteology. Comprising a Description of the 
Bones, with Colored Delineations of the Attachments of the 
Muscles. The General and Microscopical Structure of Bone and 
its Development. With Lithographic Plates and Numerous Illus- 
trations. Seventh Edition. 8vo. Cloth, 6.00 

Holden's Landmarks, Medical and Surgical. 4th ed. Clo., 1.25 

Heath's Practical Anatomy. Sixth London Edition. 24 Col- 
ored Plates, and nearly 300 other Illustrations. Cloth, 5.00 

Potter's Compend of Anatomy. Fifth Edition. Enlarged. 
16 Lithographic Plates. 117 Illustrations. See Page 14. 

Cloth, 1. 00; Interleaved for Notes, 1.25 

CHEMISTRY. 

Bartley's Medical Chemistry. Second Edition. A text-book 
prepared specially for Medical, Pharmaceutical and Dental Stu- 
dents. With 50 Illustrations, Plate of Absorption Spectra and 
Glossary of Chemical Terms. Revised and Enlarged. Cloth, 2.50 

Trimble. Practical and Analytical Chemistry. A Course in 
Chemical Analysis, by Henry Trimble, Prof, of Analytical Chem- 
istry in the Phila. College of Pharmacy. Illustrated. Fourth 
Edition, Enlarged. 8vo. Cloth, 1.50 

*^~ See pages 2 to 5 for list of Students* Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 7 

Chemistry : — Continued. 

Bloxam's Chemistry, Inorganic and Organic, with Experiments. 
Seventh Edition. Enlarged and Rewritten. 281 Illustrations. 

Cloth, 4.50 ; Leather, 5.50 

Richter's Inorganic Chemistry. A text-book for Students. 
Third American, from Fifth German Edition. Translated by 
Prof. Edgar F. Smith, ph.d. 89 Wood Engravings and Colored 
Plate of Spectra. Cloth, 2.00 

Richter's Organic Chemistry, or Chemistry of the Carbon 
Compounds. Illustrated. Second Edition. Cloth, 4.50 

Symonds. Manual of Chemistry, for the special use of Medi- 
cal Students. By Brandreth Symonds, a.m., m.d., Asst. 
Physician Roosevelt Hospital, Out-Patient Department ; Attend- 
ing Physician Northwestern Dispensary, New York. i2mo. 

Cloth, 2.00 

Leffmann's Compend of Chemistry. Inorganic and Organic. 
Including Urinary Analysis. Third Edition. Revised. 

Cloth, 1. 00; Interleaved for Notes, 1.25 

Leffmann and Beam. Progressive Exercises in Practical 
Chemistry. i2mo. Illustrated. Cloth, 1.00 

Muter. Practical and Analytical Chemistry. Fourth Edi- 
tion. Revised, to meet the requirements of American Medical 
Colleges, by Prof. C. C. Hamilton. Illustrated. Cloth, 2.00 

Holland. The Urine, Common Poisons, and Milk Analysis, 
Chemical and Microscopical. For Laboratory Use. Fourth 
Edition, Enlarged. Illustrated. Cloth, 1.00 

Van Niiys. Urine Analysis. Illus. Cloth, 2.00 

Wolff's Applied Medical Chemistry. By Lawrence Wolff, 
m.d., Dem. of Chemistry in Jefferson Medical College. Clo., 1.00 

CHILDREN. 

Goodhart and Starr. The Diseases of Children. Second 
Edition. By J. F. Goodhart, m.d., Physician to the Evelina 
Hospital for Children ; Assistant Physician to Guy's Hospital, 
London. Revised and Edited by Louis Starr, m.d., Clinical 
Professor of Diseases of Children in the Hospital of the Univer- 
sity of Pennsylvania ; Physician to' the Children's Hospital, 
Philadelphia. Containing many Prescriptions and Formulae, 
conforming to the U. S. Pharmacopoeia, Directions for making 
Artificial Human Milk, for the Artificial Digestion of Milk, etc. 
Illustrated. Cloth, 3.00; Leather, 3.50 

Hatfield. Diseases of Children. By M. P. Hatfield, m.d., 

Professor of Diseases of Children, Chicago Medical College. 

Colored Plate. i2mo. Cloth, 1. 00; Interleaved, 1.25 

4GF See pages 14 and 15 for list of ? Quiz- Comp ends? 



8 STUDENTS' TEXT-BOOKS AND MANUALS. 

Children; — Continued. 
Starr. Diseases of the Digestive Organs in Infancy and 
Childhood. With chapters on the Investigation of Disease, 
and on the General Management of Children. By Louis Starr, 
m.d., Clinical Professor of Diseases of Children in the Univer- 
sity of Pennsylvania. Illus. Second Edition. Cloth, 2.25 

DENTISTRY. 

Fillebrown. Operative Dentistry. 330 Illus. Cloth, 2.50 

Flagg's Plastics and Plastic Filling. 4th Ed. Cloth, 4.00 
Gorgas. Dental Medicine. A Manual of Materia Medica and 
Therapeutics. Fourth Edition. Cloth, 3.50 

Harris. Principles and Practice of Dentistry. Including 
Anatomy, Physiology, Pathology, Therapeutics, Dental Surgery 
and Mechanism. Twelfth Edition. Revised and enlarged by 
Professor Gorgas. 1028 Illustrations. Cloth, 7.00 ; Leather, 8.00 
Richardson's Mechanical Dentistry. Fifth Edition. 569 
Illustrations. 8vo. Cloth, 4.50; Leather, 5.50 

Sewill. Dental Surgery. 200 Illustrations. 3d Ed. Clo., 3.00 
Taft's Operative Dentistry. Dental Students and Practitioners. 
Fourth Edition. 100 Illustrations. Cloth, 4.25 ; Leather, 5.00 
Talbot. Irregularities of the Teeth, and their Treatment. 
Illustrated. 8vo. Second Edition. Cloth, 3.00 

Tomes' Dental Anatomy. Third Ed. 191 Illus. Cloth, 4.00 
Tomes' Dental Surgery. 3d Edition. Revised. 292 Illus. 
772 Pages. Cloth, 5.00 

Warren. Compend of Dental Pathology and Dental Medi- 
cine. Illustrated. Cloth, 1.00; Interleaved, 1.25 

DICTIONARIES. 

Gould's New Medical Dictionary. Containing the Definition 
and Pronunciation of all words in Medicine, with many useful 
Tables etc. ^ Dark Leather, 3.25; y 2 Mor., Thumb Index 4.25 

Harris' Dictionary of Dentistry. Fifth Edition. Completely 
revised and brought up to date by Prof. Gorgas. 

Cloth, 5.00 ; Leather, 6.00 

Cleaveland's Pronouncing Pocket Medical Lexicon. 31st 
Edition. Giving correct Pronunciation and Definition. Very 
small pocket size. Cloth, red edges .75 ; pocket-book style, 1.00 

Longley 's Pocket Dictiona ry . The Student's Medical Lexicon, 
giving Definition and Pronunciation of all Terms used in Medi- 
cine, with an Appendix giving Poisons and Their Antidotes, 
Abbreviations used in Prescriptions, Metric Scale of Doses, etc. 
24mo. Cloth, 1. 00; pocket-book style, 1.25 

4®=* See pages 2 to 5 for list of Students' Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 9 

EYE. 

Hartridge on Refraction. 5th Edition. Illus. Cloth, 2.00 

Hartridge on the Ophthalmoscope. Illustrated. Cloth, 1.50 
Meyer. Diseases of the Eye. A complete Manual for Stu- 
dents and Physicians. 270 Illustrations and two Colored Plates. 
8vo. Cloth, 4.50; Leather, 5.50 

Swanzy. Diseases of the Eye and their Treatment. 158 
Illustrations. Fourth Edition. Cloth, 3 00 

Fox and Gould. Compend of Diseases of the Eye and 
Refraction. 2d Ed. Enlarged. 71 Illus. 39 Formulae. 

Cloth, 1. 00 ; Interleaved for Notes, 1.25 

ELECTRICITY. 

Bigelow. Plain Talks on Medical Electricity and Batteries. 

Illustrated. With a Glossary of Electrical Terms. Cloth, 1.00 
Mason's Compend of Medical and Surgical Electricity. 

With numerous Illustrations. i2mo. Cloth, 1. 00 

HYGIENE. 
Parkes' (Ed. A.) Practical Hygiene. Seventh Edition, en-, 
larged. Illustrated. 8vo. Cloth, 4.50 

Parkes' (L. C.) Manual of Hygiene and Public Health. 

Second Edition. i2mo. Cloth, 2.50 

Wilson's Handbook of Hygiene and Sanitary Science. 

Seventh Edition. Revised and Illustrated. In Press. 

MATERIA MEDICA AND THERAPEUTICS. 

Potter's Compend of Materia Medica, Therapeutics and 
Prescription Writing. Fifth Edition, revised and improved. 
See Page if. Cloth, 1.00; Interleaved for Notes, 1.25 

Biddle's Materia Medica. Eleventh Edition. By the late 
John B. Biddle, m.d., Prof, of Materia Medica in Jefferson Col- 
lege, Philadelphia. Revised by Clement Biddle, m.d., and 
Henry Morris, m.d. 8vo., illustrated. Cloth, 4.25; Leather, 5.00 

Potter. Handbook of Materia Medica, Pharmacy and 
Therapeutics. Including Action of Medicines, Special Thera- 
peutics, Pharmacology, etc. By Saml. O. L. Potter, m.d., 
m.r.c.p. (Lond.), Professor of the Practice of Medicine in 
Cooper Medical College, San Francisco. Third Revised and 
Enlarged Edition. 8vo. Cloth, 4.00; Leather, 5.00 

Waring. Therapeutics. With an Index of Diseases and 
Remedies. 4th Edition. Revised. Cloth, 3.00; Leather, 3.50 
4QP" See pages 14 and ij for list of ? Quiz- Compends ? 



10 STUDENTS' TEXT-BOOKS AND MANUALS. 

MEDICAL JURISPRUDENCE. 

Reese. A Text-book of Medical Jurisprudence and Toxi- 
cology. By John J. Reese, m.d., Professor of Medical Juris- 
prudence and Toxicology in the Medical Department of the 
University of Pennsylvania ; President of the Medical Juris- 
prudence Society of Philadelphia; Physician to St. Joseph's 
Hospital ; Corresponding Member of The New York Medico- 
legal Society. Third Edition. Cloth, 3.00; Leather, 3.50 

OBSTETRICS AND GYNECOLOGY. 

Davis. A Manual of Obstetrics. By Edw. P. Davis, Dem- 
onstrator of Obstetrics, Jefferson Medical College, Philadelphia. 
Colored Plates, and 130 other Illustrations. i2mo. Cloth, 2.00 

Byford. Diseases of Women. The Practice of Medicine and 
Surgery, as applied to the Diseases and Accidents Incident to 
Women. By W. H. Byford, a.m., m.d., Professor of Gynaecology 
in Rush Medical College and of Obstetrics in the Woman's Med- 
ical College, etc., and Henry T. Byford, m.d., Surgeon to the 
Woman's Hospital of Chicago. Fourth Edition. Revised and 
Enlarged. 306 Illustrations, over 100 of which are original. 
Octavo. 832 pages. Cloth, 5.00 ; Leather, 6.00 

Cazeaux and Tarnier's Midwifery. With Appendix, by 

Munde. The Theory and Practice of Obstetrics ; including the 
Diseases of Pregnancy and Parturition, Obstetrical Operations, 
etc. Eighth American, from the Eighth French and First 
Italian Edition. Edited by Robert J. Hess, m.d., Physician to 
the Northern Dispensary, Philadelphia, with an appendix by 
Paul F. Munde, m.d., Professor of Gynaecology at the N. Y. 
Polyclinic. Illustrated by Chromo-Lithographs, and other Full- 
page Plates, seven of which are beautifully colored, and numerous 
Wood Engravings. One Vol., 8vo. Cloth, 5.00; Leather, 6.00 

Lewers' Diseases of Women. A Practical Text-Book. 139 
Illustrations. Second Edition. Cloth, 2.50 

Parvin's Winckel's Diseases of Women. Second Edition. 
Including a Section on Diseases of the Bladder and Urethra. 
150 Illus. Revised. Seepages. Cloth, 3.00; Leather, 3.50 

Morris. Compend of Gynaecology. Illustrated. Cloth, 1.00 

Winckel's Obstetrics. A Text-book on Midwifery, includ- 
ing the Diseases of Childbed. By Dr. F. Winckel, Professor 
of Gynaecology, and Director of the Royal University Clinic for 
Women, in Munich. Authorized Translation, by J. Clifton 
Edgar, m.d., Lecturer on Obstetrics, University Medical Col- 
lege, New York, with nearly 200 handsome illustrations, the 
majority of which are original. 8vo. Cloth, 6.00 ; Leather, 7.00 

Landis' Compend of Obstetrics. Illustrated. 4th edition, 
enlarged. Cloth, 1.00 ; Interleaved for Notes, 1.25 

Galabin's Midwifery. By A. Lewis Galabin, m.d., f.r.c.p. 

227 Illustrations. Seepages. Cloth, 3.00; Leather, 3.50 

JX^* See pages 2 to 5 for h'st of New Manuals, 



STUDENTS' TEXT-BOOKS AND MANUALS. 



PATHOLOGY. HISTOLOGY. BIOLOGY. 

Bowlby. Surgical Pathology and Morbid Anatomy, for 
Students. 135 Illustrations. i2mo. Cloth, 2.00 

Davis' Elementary Biology. Illustrated. Cloth, 4.00 

Gilliam's Essentials of Pathology. A Handbook for Students. 
47 Illustrations. i2mo. Cloth, 2.00 

%* The object of this book is to unfold to the beginner the funda- 
mentals of pathology in a plain, practical way, and by bringing 
them within easy comprehension to increase his interest in the study 
of the subject. 

Gibbes' Practical Histology and Pathology. Third Edition. 

Enlarged, nmo. Cloth, 1.75 

Virchov/'s Post-Mortem Examinations. 3d Ed. Cloth, 1.00 

PHYSICAL DIAGNOSIS. 

Fenwick. Student's Guide to Physical Diagnosis. 7th 
Edition. 117 Illustrations, nmo. Cloth, 2.25 

Tyson's Student's Handbook of Physical Diagnosis. Illus- 
trated. i2mo. Cloth, 1.25 

PHYSIOLOGY. 

Yeo's Physiology. Fifth Edition. The most Popular Stu- 
dents' Book. By Gerald F. Yeo, m.d., f.r.c.s., Professor of 
Physiology in King's College, London. Small Octavo. 758 
pages. 321 carefully printed Illustrations. With a Full 
Glossary and Index. See Page 3. Cloth, 3.00; Leather, 3.50 

Brubaker's Compend of Physiology. Illustrated. Sixth 
Edition. Cloth, 1. 00; Interleaved for Notes, 1.25 

Stirling. Practical Physiology, including Chemical and Ex- 
perimental Physiology. 142 Illustrations. Cloth, 2.25 

Kirke's Physiology. New 12th Ed. Thoroughly Revised and 
Enlarged. 502 Illustrations. Cloth, 4.00; Leather, 5.00 

Landois' Human Physiology. Including Histology and Micro- 
scopical Anatomy, and with special reference to Practical Medi- 
cine. Fourth Edition. Translated and Edited by Prof. Stirling. 
845 Illustrations. Cloth, 7.00; Leather, 8.00 

'' With this Text-book at his command, no student could fail in 

his examination." — Lancet. 

Sanderson's Physiological Laboratory. Being Practical Ex- 
ercises for the Student. 350 Illustrations. 8vo. Cloth, 5.00 

PRACTICE. 

Taylor. Practice of Medicine. A Manual. By Frederick 
Taylor, m.d., Physician to, and Lecturer on Medicine at, Guy's 
Hospital, London ; Physician to Evelina Hospital for Sick Chil- 
dren, and Examiner in Materia Medica and Pharmaceutical 
Chemistry, University of London. Cloth, 4.00; Leather, 5.00 

**- See pages 14 and 15 for list of ? Quiz- Com J> ends t 



12 STUDENTS' TEXT-BOOKS AND MANUALS. 

Practice : — Con tin ued. 

Roberts' Practice. New Revised Edition. A Handbook 
of the Theory and Practice of Medicine. By Frederick T. 
Roberts, m.d. ; m.r.c.p., Professor of Clinical Medicine and 
Therapeutics in University College Hospital, London. Seventh 
Edition. Octavo. Cloth, 5.50 ; Sheep, 6.50 

Hughes. Compend of the Practice of Medicine. 4th Edi- 
tion. Two parts, each, Cloth, 1.00; Interleaved for Notes, 1.25 
Part i. — Continued, Eruptive and Periodical Fevers, Diseases 

of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 

Kidneys, etc., and General Diseases, etc. 

Part ii. — Diseases of the Respiratory System, Circulatory 

System and Nervous System ; Diseases of the Blood, etc. 

Physicians' Edition. Fourth Edition. Including a Section 
on Skin Diseases. With Index. 1 vol. Full Morocco, Gilt, 2.50 

From John A. Robinson, M.D., Assistant to Chair of Clinical 
Medicine, now Lecturer on Materia Medica, Rush Medical Col- 
lege, Chicago. 
" Meets with my hearty approbation as a substitute for the 

ordinary note books almost universally used by medical students. 

It is concise, accurate, well arranged and lucid, . . . just the 

thing for students to use while studying physical diagnosis and the 

more practical departments of medicine. " 

PRESCRIPTION BOOKS. 

Wythe's Dose and Symptom Book. Containing the Doses 
and Uses of all the principal Articles of the Materia Medica, etc. 
Seventeenth Edition. Completely Revised and Rewritten. Just 
Ready. 32mo. Cloth, 1. 00; Pocket-book style, 1.25 

Pereira's Physician's Prescription Book. Containing Lists 
of Terms, Phrases, Contractions and Abbreviations used in 
Prescriptions Explanatory Notes, Grammatical Construction ot 
Prescriptions, etc., etc. By Professor Jonathan Pereira, m.d. 
Sixteenth Edition. 321110. Cloth, 1. 00; Pocket-book style, 1.25 

PHARMACY. 

Stewart's Compend of Pharmacy. Based upon Remington's 
Text-Book of Pharmacy. Third Edition, Revised. With new 
Tables, Index, Etc. Cloth, 1.00 ; Interleaved for Notes, 1.25 

Robinson. Latin Grammar of Pharmacy and Medicine. 
By H. D. Robinson, ph.d., Professor of Latin Language and 
Literature, University of Kansas, Lawrence. With an Intro- 
duction by L. E. Sayre, ph.g., Professor of Pharmacy in, and 
Dean of, the Dept. of Pharmacy, University of Kansas. i2mo. 

Cloth, 2.00 

SKIN DISEASES. 

Anderson, (McCall) Skin Diseases. A complete Text-Book, 
with Colored Plates and numerous Wood Engravings. 8vo. 

Cloth, 4.50; Leather, 5.50 

Van Harlingen on Skin Diseases. A Handbook of the Dis- 
eases of the Skin, their Diagnosis and Treatment (arranged alpha- 
betically). B} r Arthur Van Harlingen, m.d., Clinical Lecturer 
on Dermatology, Jefferson Medical College ; Prof, of Diseases of 
the Skin in the Philadelphia Polyclinic. 2d Edition. Enlarged. 
With colored and other plates and illustrations. i2mo. Cloth, 2.50 
4£tf* See pages 2 to 5 for list of New Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 13 

SURGERY AND BANDAGING. 

Moullin's Surgery, A new Text-Book. 500 Illustrations (some 
colored), 200 of which are original. 

Cloth, net 7.00; Leather, net 8.00 

Jacobson. Operations in Surgery. A Systematic Handbook 
for Physicians, Students and Hospital Surgeons. By W. H. A. 
Jacobson, b.a., Oxon. f.r.c.s. Eng. ; Ass't Surgeon Guy's Hos- 
pital ; Surgeon at Royal Hospital for Children and Women, etc. 
199 Illustrations. 1006 pages. 8vo. Cloth. 5.00; Leather, 6.00 

Heath's Minor Surgery, and Bandaging. Ninth Edition. 142 
Illustrations. 60 Formulae and Diet Lists. Cloth, 2.00 

Horwitz's Compend of Surgery, Minor Surgery and 
Bandaging, Amputations, Fractures, Dislocations, Surgical 
Diseases, and the Latest Antiseptic Rules, etc., with Differential 
Diagnosis and Treatment. By Orville Hokwitz, b.s., m.d., 
Demonstrator of Surgery, Jefferson Medical College. 4th edition. 
Enlarged and Rearranged. 136 Illustrations and 84 Formulae. 
i2mo. Cloth, 1. 00 ; Interleaved for the addition of Notes, 1.25 
***The new Section on Bandaging and Surgical Dressings, con- 
sists of 32 Pages and 41 Illustrations. Every Bandage of any 
importance is figured. This, with the Section on Ligation of 
Arteries, forms an ample Text-book for the Surgical Laboratory. 

Walsham. Manual of Practical Surgery. Third Edition. 
By Wm. J. Walsham, m.d., f.r.c.s., Asst. Surg, to, and Denr^ 
of Practical Surg, in, St. Bartholomew's Hospital ; Surgeon to 
Metropolitan Free Hospital, London. With 318 Engravings. 
See Page 2. Cloth, 3.00; Leather, 3.50 

URINE, URINARY ORGANS, ETC. 

Holland. The Urine, and Common Poisons and The 
Milk. Chemical and Microscopical, for Laboratory Use. Illus- 
trated. Fourth Edition. i2mo. Interleaved. Cloth, 1.00 

Ralfe. Kidney Diseases and Urinary Derangements. 42 Illus- 
trations. i2mo. 572 pages. Cloth, 2.75 

Marshall and Smith. On the Urine. The Chemical Analysis ot 
the Urine. By John Marshall, m.d., Chemical Laboratory, Univ. 
of Penna; and Prof. E. F. Smith, ph. d. Col. Plates. Cloth, 1. 00 

Tyson. On the Urine. A Practical Guide to the Examination 
of Urine. With Colored Plates and Wood Engravings. 7th Ed. 
Enlarged. i2mo. Cloth, 1.50 

Van Niiys, Urine Analysis. Illus. Cloth, 2.00 

VENEREAL DISEASES. 

Hill and Cooper. Student's Manual of Venereal Diseases, 
with Formulae. Fourth Edition. i2mo. Cloth, 1.0a 

*&• See pages 14 and /j for list of ? Quiz- Comp ends ? 



NEW AND REVISED EDITIONS. 

PQUIZ-COMPENDS? 

The Best Compends for Students' Use 
in the Quiz Class, and when Pre- 
paring for Examinations. 

Compiled in accordance with the latest teachings of promi- 
nent lecturers and the most popular Text-books. 

They form a most complete, practical and exhaustive 
set of manuals, containing information nowhere else col- 
lected in such a condensed, practical shape. Thoroughly 
up to the times in every respect, containing many new 
prescriptions and formulae, and over two hundred and 
fifty illustrations, many of which have been drawn and 
engraved specially for this series. The authors have had 
large experience as quiz-masters and attaches of colleges, 
with exceptional opportunities for noting the most recent 
advances and methods. 

Cloth, each $1.00. Interleaved for Notes, $1.25. 
No. 1. HUMAN ANATOMY, " Based upon Gray." Fifth 
Enlarged Edition, including Visceral Anatomy, formerly 
published separately. 16 Lithograph Plates, New- 
Tables and 117 other Illustrations. By Samuel O. L. 
Potter, m.a., m.d., m.r.c.p. (Lond.,) late A. A. Surgeon U. S. 
Army. Professor of Practice, Cooper Medical College, San Fran- 
cisco. 
Nos. 2 and 3. PRACTICE OF MEDICINE. Fourth Edi- 
tion. By Daniel E. Hughes, m.d., Demonstrator of Clinical 
Medicine in Jefferson Medical College, Philadelphia. In two parts. 
Part I. — Continued, Eruptive and Periodical Fevers, Diseases 
of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 
Kidneys, etc. (including Tests for Urine), General Diseases, etc. 

Part II. — Diseases of the Respiratory System (including Phy- 
sical Diagnosis), Circulatory System and Nervous System; Dis- 
eases of the Blood, etc. 

*** These little books can be regarded as a full set of notes upon 
the Practice of Medicine, containing the Synonyms, Definitions, 
Causes, Symptoms, Prognosis, Diagnosis, Treatment, etc., of each 
disease, and including a number of prescriptions hitherto unpub- 
lished. 

No. 4. PHYSIOLOGY, including Embryology. Sixth 
Edition. By Albert P. Brubaker, m.d., Prof, of Physiology, 
Penn'a College of Dental Surgery; Demonstrator of Physiology 
in Jefferson Medical College, Philadelphia. Revised, Enlarged, 
with new Illustrations. 
No. 5. OBSTETRICS. Illustrated. Fourth Edition. By 
Henry G. Landis, m.d., Prof, of Obstetrics and Diseases of 
Women, in Starling Medical College, Columbus, O. Revised 
Edition. New Illustrations. 



BLAKISTON'S ? QUIZ-COMPENDS ? 

No. 6. MATERIA MEDICA, THERAPEUTICS AND 
PRESCRIPTION WRITING. Fifth Revised Edition. 
With especial Reference to the Physiological Action of Drugs, 
and a complete article on Prescription Writing. Based on the 
Last Revision of the U. S. Pharmacopoeia, and including many 
unofHcinal remedies. By Samuel O. L. Potter, m.a., m.d., 
m.r.c.p. (Lond.,) late A. A. Surg. U. S. Army ; Prof, of Practice, 
Cooper Medical College, San Francisco. Improved and Enlarged, 
with Index. 

No. 7. GYNECOLOGY. A Compend of Diseases of Women. 
By Henry Morris, m.d., Demonstrator of Obstetrics, Jefferson 
Medical College, Philadelphia. 45 Illustrations. 

No. 8. DISEASES OF THE EYE AND REFRACTION, 
including Treatment and Surgery. By L. Webster Fox, m.d., 
Chief Clinical Assistant Ophthalmological Dept., Jefferson Med- 
ical College, etc., and Geo. M. Gould, m.d. 71 Illustrations, 39 
Formulae. Second Enlarged and improved Edition. Index. 

No. 9. SURGERY, Minor Surgery and Bandaging. Illus- 
trated. Fourth Edition. Including Fractures, Wounds, 
Dislocations, Sprains, Amputations and other operations ; Inflam- 
mation, Suppuration, Ulcers, Syphilis, Tumors, Shock, etc. 
Diseases of the Spine, Ear, Bladder, Testicles, Anus, and 
other Surgical Diseases. By Orville Horwitz, a.m., m.d., 
Demonstrator of Surgery, Jefferson Medical College. Revised 
and Enlarged. 84 Formulas and 136 Illustrations. 

No. 10. CHEMISTRY. Inorganic and Organic. For Medical 
and Dental Students. Including Urinary Analysis and Medical 
Chemistry. By Henry Leffmann, m.d., Prof, of Chemistry in 
Penn'a College of Dental Surgery, Phila. Third Edition, Revised 
and Rewritten, with Index. 

No. 11. PHARMACY. Based upon " Remington's Text-book 
of Pharmacy." By F. E. Stewart, m.d., ph. g., Quiz-Master 
at Philadelphia College of Pharmacy. Third Edition, Revised. 

No. 12. VETERINARY ANATOMY AND PHYSIOL- 
OGY. 29 Illustrations. By Wm. R. Ballou, m.d., Prof, of 
Equine Anatomy at N. Y. College of Veterinary Surgeons. 

No. 13. DENTAL PATHOLOGY AND DENTAL MEDI- 
CINE. Containing all the most noteworthy points of interest 
to the Dental student. By Geo. W. Warren, d.d.s., Clinical 
Chief, Penn'a College of Dental Surgery, Philadelphia. Illus. 

No. 14. DISEASES OF CHILDREN. By Dr. Marcus P. 
Hatfield, Prof, of Diseases of Children, Chicago Medical 
College. Colored Plate. 

Bound in Cloth, $1. Interleaved, for the Addition of Notes, $1.25. 



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It contains Tables of the Arteries, Bacilli, Gan- 
glia, Leucomaines, Micrococci, Muscles, 
Nerves, Plexuses, Ptomaines, etc., 
etc., that will be found of great 
use to the student. 



Small octavo, 520 pages, Half-Dark Leather, . $3.25 
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